Provider Demographics
NPI:1679962757
Name:RAJENDRAN, RAJU (PT)
Entity Type:Individual
Prefix:
First Name:RAJU
Middle Name:
Last Name:RAJENDRAN
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 1:225/64.NEW KARKANA 6TH CROSS
Mailing Address - Street 2:
Mailing Address - City:THIRUVANNAMALAI
Mailing Address - State:TAMIL NADU
Mailing Address - Zip Code:606601
Mailing Address - Country:IN
Mailing Address - Phone:91417-522-9185
Mailing Address - Fax:
Practice Address - Street 1:1020.SOUTH 23RD STREET
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707
Practice Address - Country:US
Practice Address - Phone:409-840-6169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1101087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist