Provider Demographics
NPI:1447608765
Name:RATHOD, VIJIYA S
Entity Type:Individual
Prefix:MRS
First Name:VIJIYA
Middle Name:S
Last Name:RATHOD
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 1:9881 BROKEN LAND PARKWAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046
Mailing Address - Country:US
Mailing Address - Phone:240-841-2641
Mailing Address - Fax:
Practice Address - Street 1:2634 BRANDERMILL BLVD
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1651
Practice Address - Country:US
Practice Address - Phone:410-721-7201
Practice Address - Fax:410-721-7580
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist