Provider Demographics
NPI:1174862593
Name:KHEMRAJ, RAJESH (PT)
Entity type:Individual
Prefix:
First Name:RAJESH
Middle Name:
Last Name:KHEMRAJ
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 1:1905 SE 192ND AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7415
Mailing Address - Country:US
Mailing Address - Phone:503-620-0781
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:12511 SW 68TH AVE STE 150
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8298
Practice Address - Country:US
Practice Address - Phone:503-620-0781
Practice Address - Fax:503-427-9553
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR04285225100000X
WAPT60972498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227943Medicaid
OR227943Medicaid
ORR173453Medicare PIN
ORR169090Medicare PIN