Provider Demographics
NPI:1760839997
Name:RAJAN, ROSHAN (PTA)
Entity Type:Individual
Prefix:
First Name:ROSHAN
Middle Name:
Last Name:RAJAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BALL FARM WAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-2023
Mailing Address - Country:US
Mailing Address - Phone:434-249-5006
Mailing Address - Fax:
Practice Address - Street 1:7 BALL FARM WAY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-2023
Practice Address - Country:US
Practice Address - Phone:434-249-5006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ2-0001031225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEJ2-0001031OtherDE PTA LICENSE