Healthcare Provider Details

I. General information

NPI: 1912867334
Provider Name (Legal Business Name): PREMIER PELVIC PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14218 NEWBROOK DR
CHANTILLY VA
20151-2227
US

IV. Provider business mailing address

14218 NEWBROOK DR
CHANTILLY VA
20151-2227
US

V. Phone/Fax

Practice location:
  • Phone: 410-948-3595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NASHRAH N KHAN
Title or Position: OWNER
Credential: DPT
Phone: 410-948-3595