Provider Demographics
NPI:1710045091
Name:PAL, RAJ (PT)
Entity Type:Individual
Prefix:
First Name:RAJ
Middle Name:
Last Name:PAL
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 1:2320 WOOLSEY STREET
Mailing Address - Street 2:# 111
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1974
Mailing Address - Country:US
Mailing Address - Phone:510-849-0327
Mailing Address - Fax:510-849-4072
Practice Address - Street 1:2320 WOOLSEY STREET
Practice Address - Street 2:# 111
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1974
Practice Address - Country:US
Practice Address - Phone:510-849-0327
Practice Address - Fax:510-849-4072
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 16749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPT 167490Medicare ID - Type Unspecified