Provider Demographics
NPI:1497953319
Name:IPPATOORI, RADHIKA PRIYA (MSPT)
Entity type:Individual
Prefix:MRS
First Name:RADHIKA
Middle Name:PRIYA
Last Name:IPPATOORI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5213 HICKORY PARK DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-2617
Mailing Address - Country:US
Mailing Address - Phone:048-137-1188
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:5213 HICKORY PARK DR
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-2617
Practice Address - Country:US
Practice Address - Phone:804-813-7118
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist