Provider Demographics
NPI:1043598568
Name:VIJAYAKUMAR, RAJIV (PT, DPT, MS)
Entity Type:Individual
Prefix:DR
First Name:RAJIV
Middle Name:
Last Name:VIJAYAKUMAR
Suffix:
Gender:M
Credentials:PT, DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3916 SEPULVEDA BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4640
Practice Address - Country:US
Practice Address - Phone:310-945-5705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA355842251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic