Provider Demographics
NPI:1457363640
Name:BHOGARAJU, PRASAD SATYA (PT)
Entity type:Individual
Prefix:MR
First Name:PRASAD
Middle Name:SATYA
Last Name:BHOGARAJU
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 1:26 ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9333
Mailing Address - Country:US
Mailing Address - Phone:847-894-2409
Mailing Address - Fax:
Practice Address - Street 1:874 S IL ROUTE 59
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-1633
Practice Address - Country:US
Practice Address - Phone:630-837-2705
Practice Address - Fax:630-837-2686
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist