Provider Demographics
NPI:1285907147
Name:KARODY, ATULA RAMESH (PT)
Entity type:Individual
Prefix:
First Name:ATULA
Middle Name:RAMESH
Last Name:KARODY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14297 PEAR ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-8835
Mailing Address - Country:US
Mailing Address - Phone:951-906-1379
Mailing Address - Fax:
Practice Address - Street 1:23110 ATLANTIC CIR STE D
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5920
Practice Address - Country:US
Practice Address - Phone:951-379-1500
Practice Address - Fax:951-379-1501
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2019-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGT126ZMedicare PIN