Provider Demographics
NPI:1083084982
Name:RAJAN, MADHU VASUDEVAN (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:MADHU
Middle Name:VASUDEVAN
Last Name:RAJAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 BUNNY TRL
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-7397
Mailing Address - Country:US
Mailing Address - Phone:989-225-2551
Mailing Address - Fax:989-401-3400
Practice Address - Street 1:66 BUNNY TRL
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-7397
Practice Address - Country:US
Practice Address - Phone:989-225-2551
Practice Address - Fax:989-401-3400
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006948225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist