Healthcare Provider Details

I. General information

NPI: 1619218690
Provider Name (Legal Business Name): PURE SPORTS PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2013
Last Update Date: 02/26/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 9TH ST NW
WASHINGTON DC
20001-4202
US

IV. Provider business mailing address

1218 9TH ST NW
WASHINGTON DC
20001-4202
US

V. Phone/Fax

Practice location:
  • Phone: 202-656-8184
  • Fax: 202-600-7627
Mailing address:
  • Phone: 202-656-8184
  • Fax: 202-600-7627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT870491
License Number StateDC

VIII. Authorized Official

Name: PURVI SHETH
Title or Position: CEO/OWNER
Credential: MSPT
Phone: 202-656-8184