Healthcare Provider Details

I. General information

NPI: 1548873631
Provider Name (Legal Business Name): DMITRY KARAVAEV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 SOTHERBY XING
LEWIS CENTER OH
43035-7155
US

IV. Provider business mailing address

1939 SOTHERBY XING
LEWIS CENTER OH
43035-7155
US

V. Phone/Fax

Practice location:
  • Phone: 614-425-6828
  • Fax:
Mailing address:
  • Phone: 614-425-6828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT019688
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number008921
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: