Ravi Bhushan Kukkalli, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501010604 Issued in MI

Practice address

4020 Venoy Rd Ste 700
Wayne, MI 48184-1891

Phone

(734) 727-1309

Fax

(734) 727-1319

NPI assigned

Jun 14, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Preferred Rehab Care Inc

  • Physical Therapist
  • Wayne, MI
  • NPI 1649472960
  Medicare reassignment Authorized official
• Mansach Enterprises LLC

  • Multi-Specialty Clinic/Center
  • Pontiac, MI
  • NPI 1477989937

  Physical Therapist

  Medicare reassignment NPD
• Mansach Enterprises LLC

  • Community/Behavioral Health Agency
  • Pontiac, MI
  • NPI 1043918659
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1174727903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4020 VENOY RD STE 700",
            "city": "WAYNE",
            "state": "MI",
            "postal_code": "481841891",
            "telephone_number": "734-727-1309",
            "fax_number": "734-727-1319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 VENOY RD STE 700",
            "city": "WAYNE",
            "state": "MI",
            "postal_code": "481841891",
            "telephone_number": "734-727-1309",
            "fax_number": "734-727-1319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUKKALLI",
        "first_name": "RAVI",
        "middle_name": "BHUSHAN",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-14",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501010604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "65-0-F3-1405-0",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carolyn Kristina Kowalski, MSW, LMSW, QIDP
• KP Anandakrishnan MD PC
• Amanda Kraus
• Amanda Krausz
• Kate Krautbauer
• Neelam B Kumar, MD
• Carol Kuyava, LBSW
• Christopher Lajeunesse, MD
• Sarah Lake, LLPC
• Lakeshore Kidney Care, PLLC

• Physical Therapist in Wayne, MI
• Providers in Wayne, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.