Provider Demographics
NPI:1548815020
Name:ALAPAKAM REDDIVARI KUMARA VENKATA, RAGHUNANDAN
Entity type:Individual
Prefix:
First Name:RAGHUNANDAN
Middle Name:
Last Name:ALAPAKAM REDDIVARI KUMARA VENKATA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 N GREELEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-2748
Mailing Address - Country:US
Mailing Address - Phone:804-874-9097
Mailing Address - Fax:
Practice Address - Street 1:363 N GREELEY AVE
Practice Address - Street 2:
Practice Address - City:CHAPPAQUA
Practice Address - State:NY
Practice Address - Zip Code:10514-2748
Practice Address - Country:US
Practice Address - Phone:804-874-9097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0398302251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics