Active NPI
Supriya Ravuru
- Physical Therapist
- Fairfax, VA
National Provider Identifier
1578049615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2305208320
- Practice address
- 12475 Lee Jackson Memorial Hwy
Fairfax, VA 22033-2803 - Phone
- (703) 352-7172
- NPI assigned
- Jul 12, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2305208320 | VA | Primary |
Addresses
Primary practice location
12475 Lee Jackson Memorial Hwy
Fairfax, VA 22033-2803
Mailing address
22683 Beacon Crest Ter
Brambleton, VA 20148-6427
Phone (516) 279-9939
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B69665178 | Other | VA | DRIVERS LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531353600000",
"number": "1578049615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22683 BEACON CREST TER",
"city": "BRAMBLETON",
"state": "VA",
"postal_code": "201486427",
"telephone_number": "516-279-9939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12475 LEE JACKSON MEMORIAL HWY",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220332803",
"telephone_number": "703-352-7172"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAVURU",
"first_name": "SUPRIYA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-07-12",
"last_updated": "2018-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": "VA",
"license": "2305208320",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVERS LICENSE",
"identifier": "B69665178",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.