Provider Demographics
NPI:1427299155
Name:TANEJA, ANURAG (MSPT)
Entity type:Individual
Prefix:MR
First Name:ANURAG
Middle Name:
Last Name:TANEJA
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 OXFORD RD
Mailing Address - Street 2:APARTMENT B8
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1540
Mailing Address - Country:US
Mailing Address - Phone:214-934-0531
Mailing Address - Fax:
Practice Address - Street 1:13631 W 11 MILE RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1151
Practice Address - Country:US
Practice Address - Phone:248-298-0433
Practice Address - Fax:248-298-0434
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist