Healthcare Provider Details

I. General information

NPI: 1548323272
Provider Name (Legal Business Name): VIRAJ PANDYA CHANG PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2006
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42751 CHATELAIN CIR
BRAMBLETON VA
20148-7273
US

IV. Provider business mailing address

42751 CHATELAIN CIR
BRAMBLETON VA
20148-7273
US

V. Phone/Fax

Practice location:
  • Phone: 571-308-8094
  • Fax:
Mailing address:
  • Phone: 571-308-8094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305205580
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21244
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: