=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114469848
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALPHA PHYSICAL AND AQUATIC THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2016
-----------------------------------------------------
Last Update Date | 03/10/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5860 COLUMBIA PIKE SUITE 104
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22041-2038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-366-5900
-----------------------------------------------------
Fax | 703-998-4060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5860 COLUMBIA PIKE SUITE 104
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22041-2038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-366-5900
-----------------------------------------------------
Fax | 703-998-4060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANGER
-----------------------------------------------------
Name | MUHAMMAD JAHANGIR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-587-3171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------