Healthcare Provider Details

I. General information

NPI: 1669762464
Provider Name (Legal Business Name): RAMA DEVI KETHU PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9537 VALENCIA AVE NW
CONCORD NC
28027-3535
US

IV. Provider business mailing address

9537 VALENCIA AVE NW
CONCORD NC
28027-3535
US

V. Phone/Fax

Practice location:
  • Phone: 903-227-7599
  • Fax:
Mailing address:
  • Phone: 903-227-7599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP025062T
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP15703
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501014661
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: