Provider Demographics
NPI:1124239785
Name:RAVINDRAN, VINODH (PT)
Entity type:Individual
Prefix:
First Name:VINODH
Middle Name:
Last Name:RAVINDRAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 WEATHERLY DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043
Mailing Address - Country:US
Mailing Address - Phone:931-802-5075
Mailing Address - Fax:931-802-5085
Practice Address - Street 1:781 WEATHERLY DR
Practice Address - Street 2:SUITE F
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:US
Practice Address - Phone:931-802-5075
Practice Address - Fax:931-802-5085
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012789225100000X
TN8359225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist