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General NPI Number Information
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NPI Number | 1023677200
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Entity Type | Individual
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Provider Name | ANJALI R GHODAKE DPT
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Gender | Female
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Dates
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Enumeration Date | 06/11/2019
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 2441 N HARRISON ST STE 2443
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City | ARLINGTON
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State | VA
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Zip | 22207-1611
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Country | US
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Telephone | 571-533-3686
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Fax | 571-534-4800
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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Country | US
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Telephone | 866-370-8206
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Fax | 517-435-3670
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 27395
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License Number State | MD
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