Provider Demographics
NPI:1871705293
Name:RAMAKRISHNAN, VIMALA
Entity type:Individual
Prefix:MS
First Name:VIMALA
Middle Name:
Last Name:RAMAKRISHNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 N HANCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3153
Mailing Address - Country:US
Mailing Address - Phone:719-661-0774
Mailing Address - Fax:
Practice Address - Street 1:4566 ORANGE BLVD STE 1000
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9104
Practice Address - Country:US
Practice Address - Phone:877-896-3660
Practice Address - Fax:877-345-7994
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-0537225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant