Provider Demographics
NPI:1154835486
Name:RAO, POORNIMA (PT)
Entity type:Individual
Prefix:MS
First Name:POORNIMA
Middle Name:
Last Name:RAO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:POORNIMA
Other - Middle Name:RAO
Other - Last Name:MURTHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1610 CHISHOLM TRL
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-0929
Mailing Address - Country:US
Mailing Address - Phone:636-639-0828
Mailing Address - Fax:
Practice Address - Street 1:1610 CHISHOLM TRL
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-0929
Practice Address - Country:US
Practice Address - Phone:636-639-0828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-22
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1284589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist