1215334990 NPI number — PRAVIN XAVIER GNANASEKHAR OTR/L

Table of content: PRAVIN XAVIER GNANASEKHAR OTR/L (NPI 1215334990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215334990 NPI number — PRAVIN XAVIER GNANASEKHAR OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GNANASEKHAR
Provider First Name:
PRAVIN
Provider Middle Name:
XAVIER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215334990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
865 SAINT SIMONS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45458-2876
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-304-4244
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 E WOODBURY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45415-2841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-938-1523
Provider Business Practice Location Address Fax Number:
937-938-6877
Provider Enumeration Date:
11/25/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT006920 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com