Provider Demographics
NPI:1770128860
Name:VIJAYAKUMAR, ANJANA
Entity type:Individual
Prefix:
First Name:ANJANA
Middle Name:
Last Name:VIJAYAKUMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13782 COOK ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-8740
Mailing Address - Country:US
Mailing Address - Phone:309-831-9872
Mailing Address - Fax:
Practice Address - Street 1:9101 PEARL ST STE 350
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4390
Practice Address - Country:US
Practice Address - Phone:720-328-1246
Practice Address - Fax:720-389-6543
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0016551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist