Healthcare Provider Details

I. General information

NPI: 1023815248
Provider Name (Legal Business Name): UNKNOWN NEHA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21475 RIDGETOP CIR STE 260
STERLING VA
20166-8580
US

IV. Provider business mailing address

PO BOX 650501
STERLING VA
20165-0501
US

V. Phone/Fax

Practice location:
  • Phone: 703-433-2500
  • Fax: 703-433-2558
Mailing address:
  • Phone: 703-433-2500
  • Fax: 703-433-2558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2305216915
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: