MEDICARE: BHASKARAN RAJU PT

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	225100000X	Physical Therapist		MI

General Provider Information

NPI Number	:	1245269893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BHASKARAN RAJU PT

Provider Business Mailing Address
First Line	:	2222 SULLIVAN TRL
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18040-7958
Country	:	US
Telephone Number	:	610-991-2034
Fax Number	:

Provider Business Practice Location Address
First Line	:	3345 MILITARY ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-6680
Country	:	US
Telephone Number	:	810-966-9339
Fax Number	:

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/08/2007

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