=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780702373
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PUJA SURESH CHARAIPOTRA P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 08/31/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6849 OLD DOMINION DR SUITE 221
-----------------------------------------------------
City | MCLEAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22101-3724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-848-9333
-----------------------------------------------------
Fax | 703-848-0660
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10881 MIMOSA PL
-----------------------------------------------------
City | OAKTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22124-2427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-268-5585
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | 2305202194
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------