MEDICARE: RAJ PHYSICAL REHABILITATION CENTER,P.A.

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	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y923C	OTHER	FL	BLUE CROSS BLUE SHIELD
2	6697451	OTHER	FL	GHI

General Provider Information

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

Provider Business Mailing Address
First Line	:	6200 W ATLANTIC AVE
Second Line	:	#201
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-3501
Country	:	US
Telephone Number	:	561-499-3041
Fax Number	:	561-499-3042

Provider Business Practice Location Address
First Line	:	6200 W ATLANTIC AVE
Second Line	:	#201
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-3501
Country	:	US
Telephone Number	:	561-499-3041
Fax Number	:	561-499-3042

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NAGARAJA TIRUVALAM
Credential	:	PT
Telephone Number	:	561-499-3041

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	01/20/2011

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