Srikanth Desiraju
Individual provider Active NPI Physical Therapist · Painted Post, NY
NPI 1407980907 · NPPES record last updated Sep 8, 2010
Key facts
- NPI
- 1407980907
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 029420 (NY)
- Practice address
- 22 Dreams LN N
Painted Post, NY 14870-9100 - Phone
- (770) 639-8302
- NPI assigned
- Mar 15, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Rehab by Rvna LLC
Rvnahealth, Inc
Practice addresses (Care Compare)
27 Governor St
Ridgefield, CT 06877-4608
Phone (203) 438-7862
27 Governor St
Ridgefield, CT 06877-4657
Phone (203) 438-5555
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170825000580 | CT | Practitioner - Physical Therapist in Private Practice | 8426246752 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501012510 | MI | MD | Contractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rvnahealth, Inc. | Current |
Accepting new patients | |
| Rehab by Rvna, LLC | Current |
Accepting new patients | |
| Rvnahealth, Inc. | Current |
Accepting new patients | |
| Seneca Cayuga Counties Chapter Nysarc, Inc. | Past | Accepting new patients |
Locations
27 Governor St
Ridgefield, CT 06877
Phone (203) 438-5555
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 5501012510 | MI | |
| Physical Therapist | 225100000X | 029420 | NY | Yes |
Addresses
Primary practice location
22 Dreams LN N
Painted Post, NY 14870-9100
Mailing address
22 Dreams LN N
Painted Post, NY 14870-9100
Phone (770) 639-8302
Other providers in Painted Post, NY
- Miriam M Cummings
- Carly Cushing
- Kim M Dahl
- Bianca Daudelin
- Katherine M Deragon
- Noorpreet Kaur Dhawan
- Michael Diehr
- Kaitlyn Elizabeth Diperna
- Tammy Jo Divens
- Donald D. Smith D.M.D.,PC
All providers in Painted Post, NY · Physical Therapist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.