Provider Demographics
NPI:1962771089
Name:PEELA, RAGHUPATHI
Entity type:Individual
Prefix:
First Name:RAGHUPATHI
Middle Name:
Last Name:PEELA
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 1:2752 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4706
Mailing Address - Country:US
Mailing Address - Phone:718-769-9001
Mailing Address - Fax:718-769-9002
Practice Address - Street 1:2752 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4706
Practice Address - Country:US
Practice Address - Phone:718-769-9001
Practice Address - Fax:718-769-9002
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist