=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629287511
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JODY SHAPIRO GANDY PT, PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 NORTH FAIRFAX STREET
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22314-1488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-706-3201
-----------------------------------------------------
Fax | 703-706-3387
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2409 ALTENBURG CT
-----------------------------------------------------
City | WALDORF
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20603-3205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-374-6985
-----------------------------------------------------
Fax | 301-374-6985
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT 000982-E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------