Healthcare Provider Details

I. General information

NPI: 1184030314
Provider Name (Legal Business Name): ANAHITA VAZIRITABAR-MANII PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46909 ANTLER CT
STERLING VA
20164-8624
US

IV. Provider business mailing address

46909 ANTLER CT
STERLING VA
20164-8624
US

V. Phone/Fax

Practice location:
  • Phone: 571-299-8519
  • Fax:
Mailing address:
  • Phone: 571-299-8519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305208549
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT871196
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: