Healthcare Provider Details

I. General information

NPI: 1871424143
Provider Name (Legal Business Name): RAJESWARI MALLAVARAPU PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1184 MYRTLE AVE
BROOKLYN NY
11221-7768
US

IV. Provider business mailing address

1184 MYRTLE AVE
BROOKLYN NY
11221-7768
US

V. Phone/Fax

Practice location:
  • Phone: 347-915-6575
  • Fax: 347-503-4090
Mailing address:
  • Phone: 718-715-4871
  • Fax: 347-503-4090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number055843
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: