Provider Demographics
NPI:1780166389
Name:PERAKATHU, REENU CHACKO (PT)
Entity type:Individual
Prefix:
First Name:REENU
Middle Name:CHACKO
Last Name:PERAKATHU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:REENU
Other - Middle Name:
Other - Last Name:CHACKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19665 FM 508
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-1774
Mailing Address - Country:US
Mailing Address - Phone:956-564-9121
Mailing Address - Fax:
Practice Address - Street 1:3475 W ALTON GLOOR BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-4474
Practice Address - Country:US
Practice Address - Phone:956-350-2143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1293637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist