Provider Demographics
NPI:1871580191
Name:RAJ PHYSICAL REHABILITATION CENTER,P.A.
Entity type:Organization
Organization Name:RAJ PHYSICAL REHABILITATION CENTER,P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAGARAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIRUVALAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-499-3041
Mailing Address - Street 1:6200 W ATLANTIC AVE
Mailing Address - Street 2:#201
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-3501
Mailing Address - Country:US
Mailing Address - Phone:561-499-3041
Mailing Address - Fax:561-499-3042
Practice Address - Street 1:6200 W ATLANTIC AVE
Practice Address - Street 2:#201
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-3501
Practice Address - Country:US
Practice Address - Phone:561-499-3041
Practice Address - Fax:561-499-3042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY923COtherBLUE CROSS BLUE SHIELD
FL6697451OtherGHI
FLK6771Medicare ID - Type Unspecified