Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ravi Bhushan Kukkalli, PT

Individual provider Physical Therapist · NPI 1174727903

Ravi Bhushan Kukkalli, PT is a Physical Therapist in Private Practice in Wayne, Michigan. Qualified in 1998, 28 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
28
Licensed in
MI
In the registry since
2007
Specialties on file
2
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.

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Practice location Address checks out

4020 Venoy Rd Ste 700
Wayne, MI 48184-1891
Phone: (734) 727-1309
Fax: (734) 727-1319
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 5501010604 (MI)
Physical Therapist Taxonomy 225100000X

Record details

NPI number1174727903
Entity typeIndividual (Type 1)
GenderMale
Credentials PT
Sole proprietorYes
NPI enumeratedJune 14, 2007
Last updated in NPPESOctober 15, 2024
Certification dateOctober 15, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 1998 (28 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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