Healthcare Provider Details

I. General information

NPI: 1508686791
Provider Name (Legal Business Name): KEERTI GOORAH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6343 DOGWOOD PL
FALLS CHURCH VA
22041-1208
US

IV. Provider business mailing address

6343 DOGWOOD PL
FALLS CHURCH VA
22041-1208
US

V. Phone/Fax

Practice location:
  • Phone: 678-447-5754
  • Fax:
Mailing address:
  • Phone: 678-447-5754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. KEERTI GOORAH
Title or Position: OWNER
Credential: DPT
Phone: 678-447-5754