Provider Demographics
NPI:1972817336
Name:KAVASERRY, RAMAKRISHNAN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:RAMAKRISHNAN
Middle Name:
Last Name:KAVASERRY
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 GASKINS RD STE A
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23238-1402
Mailing Address - Country:US
Mailing Address - Phone:804-396-6753
Mailing Address - Fax:
Practice Address - Street 1:2620 GASKINS RD STE A
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23238-1402
Practice Address - Country:US
Practice Address - Phone:804-874-2476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist