Provider Demographics
NPI:1184954935
Name:RADHAKRISHNAN, MOHANRAJI (RPT)
Entity type:Individual
Prefix:
First Name:MOHANRAJI
Middle Name:
Last Name:RADHAKRISHNAN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21125 BUSENBARK LN
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-7015
Mailing Address - Country:US
Mailing Address - Phone:734-675-1431
Mailing Address - Fax:734-675-0001
Practice Address - Street 1:21125 BUSENBARK LN
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-7015
Practice Address - Country:US
Practice Address - Phone:734-675-1431
Practice Address - Fax:734-675-0001
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist