MEDICARE: MADHURA A GURJAR PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT870994	DC
2	225100000X	Physical Therapist	551012801	MI
3	225100000X	Physical Therapist	2305205819	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2307001242	OTHER	VA	DIRECT ACCESS CERTIFICATION

General Provider Information

NPI Number	:	1154379303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADHURA A GURJAR PT

Provider Business Mailing Address
First Line	:	PO BOX 2901
Second Line	:
City	:	MERRIFIELD
State	:	VA
Zip	:	22116-2901
Country	:	US
Telephone Number	:	703-646-2250
Fax Number	:	703-991-5649

Provider Business Practice Location Address
First Line	:	2841 HARTLAND RD STE 403
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22043-3500
Country	:	US
Telephone Number	:	703-646-2250
Fax Number	:	703-991-5649

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	04/17/2024

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Directions to “ MADHURA A GURJAR PT” Practice Location

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