Provider Demographics
NPI:1023539988
Name:VANAPALA, RAJAJITENDRA VARMA (PT)
Entity Type:Individual
Prefix:MR
First Name:RAJAJITENDRA
Middle Name:VARMA
Last Name:VANAPALA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 W. PARK
Mailing Address - Street 2:PRESENCE COVENANT MEDICAL CENTER
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801
Mailing Address - Country:US
Mailing Address - Phone:217-337-2109
Mailing Address - Fax:217-337-4603
Practice Address - Street 1:1400 W. PARK
Practice Address - Street 2:PRESENCE COVENANT MEDICAL CENTER
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801
Practice Address - Country:US
Practice Address - Phone:217-337-2000
Practice Address - Fax:217-337-4603
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2251C2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary