Healthcare Provider Details

I. General information

NPI: 1871580191
Provider Name (Legal Business Name): RAJ PHYSICAL REHABILITATION CENTER,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 W ATLANTIC AVE #201
DELRAY BEACH FL
33484-3501
US

IV. Provider business mailing address

6200 W ATLANTIC AVE #201
DELRAY BEACH FL
33484-3501
US

V. Phone/Fax

Practice location:
  • Phone: 561-499-3041
  • Fax: 561-499-3042
Mailing address:
  • Phone: 561-499-3041
  • Fax: 561-499-3042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NAGARAJA TIRUVALAM
Title or Position: PRESIDENT
Credential: PT
Phone: 561-499-3041