Healthcare Provider Details

I. General information

NPI: 1699681619
Provider Name (Legal Business Name): PECHARAT KITIJARURAT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12581 MILSTEAD WAY STE 201
WOODBRIDGE VA
22192-5446
US

IV. Provider business mailing address

12581 MILSTEAD WAY STE 201
WOODBRIDGE VA
22192-5446
US

V. Phone/Fax

Practice location:
  • Phone: 703-763-3922
  • Fax: 703-763-3927
Mailing address:
  • Phone: 703-763-3922
  • Fax: 703-763-3927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217985
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: