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General NPI Number Information
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NPI Number | 1366775199
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Entity Type | Individual
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Provider Name | RAJAVARMAN RAJENDRAN P.T.
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Gender | Male
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Dates
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Enumeration Date | 09/11/2009
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 2346 WISTERIA DR SUITE 110
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City | SNELLVILLE
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State | GA
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Zip | 30078-8847
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Country | US
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Telephone | 404-889-8826
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Fax |
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Provider Business Mailing Address
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Address Line | 1002 BERGERON PLACE
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City | SANDY SPRINGS
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State | GA
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Zip | 30328
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Country | US
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Telephone | 770-558-0610
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1177460
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT011513
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License Number State |
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