Provider Demographics
NPI:1023540622
Name:RAJALA, GEORGETA
Entity Type:Individual
Prefix:
First Name:GEORGETA
Middle Name:
Last Name:RAJALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23023 ORCHARD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3209
Mailing Address - Country:US
Mailing Address - Phone:248-345-3595
Mailing Address - Fax:
Practice Address - Street 1:22521 GLENMOOR HTS
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-3523
Practice Address - Country:US
Practice Address - Phone:248-345-3595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-01
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501009191225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist