=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508686791
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEERTI GOORAH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2024
-----------------------------------------------------
Last Update Date | 09/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6343 DOGWOOD PL
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22041-1208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-447-5754
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6343 DOGWOOD PL
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22041-1208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-447-5754
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KEERTI GOORAH
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 678-447-5754
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------