Provider Demographics
NPI:1982735619
Name:AUDI, RAJA (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:RAJA
Middle Name:
Last Name:AUDI
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 BUCKINGHAM RD APT 716
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5733
Mailing Address - Country:US
Mailing Address - Phone:402-305-2055
Mailing Address - Fax:
Practice Address - Street 1:530 BUCKINGHAM RD APT 716
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5733
Practice Address - Country:US
Practice Address - Phone:402-305-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1169178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX93JNOtherBCBS OF TEXAS GROUP ID
TX1164403036OtherEMPLOYER'S NPI NUMBER
TX1169178OtherP.T. LICENSE NUMBER
TX251902066OtherEMPLOYER'S TAX ID NUMBER