Revathi Lakkakula Liechty, D.P.T

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P18103 Issued in NC

Practice address

2826 Randolph Rd FL 2
Charlotte, NC 28211-1359

Phone

(704) 366-5521

NPI assigned

Mar 27, 2017

Last updated

Feb 24, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Select Physical Therapy Holdings IncGroup PAC ID 9537076401, 1,992 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Select Physical Therapy Holdings Inc

  dba Select Physical Therapy

  • Physical Therapy Clinic/Center
  • Charlotte, NC
  • NPI 1669432175
  Medicare reassignment Care Compare group NPD
• Proactive Therapy of North Carolina Inc

  dba NovaCare Rehabilitation

  • Physical Therapy Clinic/Center
  • Charlotte, NC
  • NPI 1568468502
  Medicare reassignment NPD
• Proactive Therapy of North Carolina Inc

  dba Select Physical Therapy

  • Physical Therapy Clinic/Center
  • Southern Pines, NC
  • NPI 1497426225
  NPD
• Proactive Therapy of North Carolina Inc

  dba Select Physical Therapy

  • Physical Therapy Clinic/Center
  • Raleigh, NC
  • NPI 1689679433
  NPD
• Select Physical Therapy Holdings Inc

  dba Select Physical Therapy

  • Rehabilitation Clinic/Center
  • Denver, NC
  • NPI 1437107687
  NPD
• Comprehab LLC

  dba Compleat KiDZ Pediatric Therapy

  • Physical Therapist
  • Gastonia, NC
  • NPI 1407932775
  NPD (past)
• Complete Rehabilitation and Sports Physical Therapy, PC

  • Physical Therapist
  • Ronkonkoma, NY
  • NPI 1811097306
  NPD (past)
• Select Physical Therapy Holdings Inc

  dba Select Physical Therapy

  • Rehabilitation Clinic/Center
  • Bethany, OK
  • NPI 1437110020
  NPD (past)
• Select Physical Therapy Holdings Inc

  dba Select Physical Therapy

  • Rehabilitation Clinic/Center
  • Tulsa, OK
  • NPI 1811958440
  NPD (past)

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

{
    "created_epoch": "1490572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677196800000",
    "number": "1336670702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2826 RANDOLPH RD FL 2",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111359",
            "telephone_number": "704-366-5521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2826 RANDOLPH RD FL 2",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111359",
            "telephone_number": "704-366-5521"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2675 Court Dr",
            "address_purpose": "LOCATION",
            "city": "Gastonia",
            "state": "NC",
            "postal_code": "280541478",
            "country_code": "US",
            "telephone_number": "704-824-7800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIECHTY",
        "first_name": "REVATHI",
        "middle_name": "LAKKAKULA",
        "credential": "D.P.T",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-27",
        "last_updated": "2023-02-24",
        "certification_date": "2023-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P18103",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OK",
            "license": "5275",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eliza Lezin Lieberman, LCMHCA
• Jesse Lieberman, MD
• Michelle L Lieberman, OT
• Larry Liebgold, LPC
• Brooke Lieblich, RDN, LDN
• Gertrude H Lierman, LMFT
• Anna Liersaph, L.P.C.
• Abigail Marie Liescheidt
• Robert M Liesman, DPM
• Timothy Edward Lietz, M.D.

• Physical Therapist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2023; 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.