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Individual
SUPRIYA RAVURU
Active
Individual
SUPRIYA RAVURU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305208320
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B69665178
DRIVERS LICENSE
VA
Enumeration date
07/12/2018
Last updated
07/12/2018
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