Provider Demographics
NPI:1093761314
Name:SHARMA, RAJENDRA C (PHYSICALTHERAPIST)
Entity Type:Individual
Prefix:MR
First Name:RAJENDRA
Middle Name:C
Last Name:SHARMA
Suffix:
Gender:M
Credentials:PHYSICALTHERAPIST
Other - Prefix:MR
Other - First Name:RAJENDRA
Other - Middle Name:C
Other - Last Name:SHARMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYSICALTHERAPIST
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49081-0730
Mailing Address - Country:US
Mailing Address - Phone:269-217-0670
Mailing Address - Fax:
Practice Address - Street 1:5811 S WESTNEDGE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-1456
Practice Address - Country:US
Practice Address - Phone:269-217-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23792251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic