# RAVI YADAVA, D.O. PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Performance Rehabilitation
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114155124
- **Authorized official:** DR. RAVI YADAVA D.O. (PHYSICIAN)
- **Authorized official phone:** (314) 994-9355

## Contact information

- **Practice address:** 675 OLD BALLAS RD, SUITE 210, SAINT LOUIS, MO 63141-7083
- **Practice address phone:** (314) 994-9355
- **Practice address fax:** (314) 994-0796
- **Mailing address:** 675 OLD BALLAS RD, SUITE 210, SAINT LOUIS, MO 63141-7083
- **Mailing address phone:** (314) 994-9355
- **Mailing address fax:** (314) 994-0796

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 104036 | MO | Yes |

## Other

- **Enumeration date:** 06/29/2009
- **Last updated:** 06/29/2009