Individual
RAJCOOMAR ISSUREE
Active
Individual
RAJCOOMAR ISSUREE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT670
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010138628
REGENCE BLUE SHIELD OF ID
ID
05
—
806834400
—
ID
01
—
TD767
BLUE CROSS OF ID
ID
Enumeration date
07/14/2006
Last updated
03/29/2010
Update your record
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