MEDICARE: PRITI RAVISHANKAR PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA01475200	NJ

General Provider Information

NPI Number	:	1760465074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRITI RAVISHANKAR PT

Provider Business Mailing Address
First Line	:	PO BOX 416495
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-2792
Country	:	US
Telephone Number	:	914-294-4050
Fax Number	:	631-760-8306

Provider Business Practice Location Address
First Line	:	300 PRINCETON HIGHTSTOWN RD STE 201
Second Line	:
City	:	EAST WINDSOR
State	:	NJ
Zip	:	08520-1411
Country	:	US
Telephone Number	:	609-426-4442
Fax Number	:	609-443-0910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	05/20/2021

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