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General NPI Number Information
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NPI Number | 1447731419
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Entity Type | Individual
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Provider Name | ARJUN DUTT PT , MPT , DPT
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Gender | Male
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 621 BERRY HILL RD
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-2207
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Country | US
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Telephone | 909-653-6648
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Fax |
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Provider Business Mailing Address
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Address Line | 621 BERRY HILL RD
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-2207
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Country | US
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Telephone | 909-653-6648
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Fax |
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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 | 2305211560
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License Number State | VA
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