Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Labutale Walawwe Rajaguru, PA-C

Individual provider Physician Assistant · NPI 1346006772

Labutale Walawwe Rajaguru, PA-C is a Physician Assistant in Superior, Wisconsin. Qualified in 2023, 3 years ago. Practices with Advantage Physical Therapy and Sports Rehab, LLC, a 286-clinician group and accepts Medicare assignment. Licensed in Minnesota and Wisconsin.

Years since qualifying
3
Licensed in
MN, WI
In the registry since
2024
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

3500 Tower Ave
Superior, WI 54880-4491
Phone: (715) 817-7100
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 7735 (WI)
Physician Assistant Taxonomy 363A00000X · Licence 14754 (MN)

Record details

NPI number1346006772
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedFebruary 23, 2024
Last updated in NPPESFebruary 23, 2024
Certification dateFebruary 23, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Advantage Physical Therapy And Sports Rehab, Llc — 286 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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