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General NPI Number Information
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NPI Number | 1679962757
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Entity Type | Individual
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Provider Name | RAJU RAJENDRAN P.T
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Gender | Male
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 1020.SOUTH 23RD STREET
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City | BEAUMONT
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State | TX
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Zip | 77707
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Country | US
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Telephone | 409-840-6169
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Fax |
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Provider Business Mailing Address
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Address Line | 225/64.NEW KARKANA 6TH CROSS
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City | THIRUVANNAMALAI
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State | TAMIL NADU
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Zip | 606601
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Country | IN
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Telephone | 914175229185
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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 | 1101087
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License Number State | TX
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