Basic Information
| Provider Information | |||||||||
| NPI: | 1659836781 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAO | ||||||||
| FirstName: | SRIDEVI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PT,DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 54 CLIPPER WAY | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292297005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034798551 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1007 N KINGS ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292231916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8036994111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2019 | ||||||||
| LastUpdateDate: | 02/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5056 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.