MEDICARE: MRS. RAJESHWARI N IYER MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251G0304X	Geriatric Physical Therapist	11925-24	WI
2	2251G0304X	Geriatric Physical Therapist	070.018708	IL

General Provider Information

NPI Number	:	1811230253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RAJESHWARI N IYER MPT

Provider Business Mailing Address
First Line	:	2738 PARK PLACE LN APT 39
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53545-5267
Country	:	US
Telephone Number	:	909-362-2994
Fax Number	:

Provider Business Practice Location Address
First Line	:	2738 PARK PLACE LN APT 39
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53545-5267
Country	:	US
Telephone Number	:	909-362-2994
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2013
Last Update Date	:	04/04/2013

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