Provider Demographics
NPI:1467881193
Name:ARJA, YUGANDHAR (PT)
Entity Type:Individual
Prefix:
First Name:YUGANDHAR
Middle Name:
Last Name:ARJA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 W SQUIRE DR APT 8
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1747
Mailing Address - Country:US
Mailing Address - Phone:636-697-6173
Mailing Address - Fax:
Practice Address - Street 1:27 W SQUIRE DR APT 8
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1747
Practice Address - Country:US
Practice Address - Phone:636-697-6173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034875-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY034875-1OtherNYSED