Healthcare Provider Details

I. General information

NPI: 1497638514
Provider Name (Legal Business Name): RAJDEEP KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N BROADWAY
WIND GAP PA
18091-1214
US

IV. Provider business mailing address

4300 BEECH DR
NAZARETH PA
18064-8627
US

V. Phone/Fax

Practice location:
  • Phone: 732-375-1661
  • Fax:
Mailing address:
  • Phone: 646-764-6478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPT033446
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT033446
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: