Provider Demographics
NPI:1619964921
Name:TIRUVALAM, NAGARAJA (PT)
Entity Type:Individual
Prefix:
First Name:NAGARAJA
Middle Name:
Last Name:TIRUVALAM
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 1:6200 W ATLANTIC AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-3506
Mailing Address - Country:US
Mailing Address - Phone:561-499-3041
Mailing Address - Fax:561-499-3042
Practice Address - Street 1:6200 W ATLANTIC AVE
Practice Address - Street 2:#201
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-3506
Practice Address - Country:US
Practice Address - Phone:561-499-3041
Practice Address - Fax:561-499-3042
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6697453OtherGHI
FLY7949OtherBLUE CROSS BLUE SHIELD
FLE1436XMedicare ID - Type UnspecifiedPHYSICAL THERAPIST