Healthcare Provider Details

I. General information

NPI: 1467775742
Provider Name (Legal Business Name): RACOVI THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8146 BIRCHFIELD DR
INDIANAPOLIS IN
46268-2895
US

IV. Provider business mailing address

PO BOX 681401
INDIANAPOLIS IN
46268-7401
US

V. Phone/Fax

Practice location:
  • Phone: 812-841-9410
  • Fax: 317-755-1773
Mailing address:
  • Phone: 812-841-9410
  • Fax: 317-755-1773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND CORTES VILLANUEVA
Title or Position: OWNER
Credential: PT
Phone: 812-841-9410