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NPI Code Detail

MEDICARE: MARAL JAVADIFAR DPT

MEDICARE: MARAL JAVADIFAR DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2305209658VA
2225100000XPhysical Therapist34584FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12305209658OTHERVASTATE LICENSE NUMBER

General Provider Information

NPI Number : 1114303112
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARAL JAVADIFAR DPT
Provider Business Mailing Address
First Line : 4084 UNIVERSITY DR
Second Line : SUITE 103
City : FAIRFAX
State : VA
Zip : 22030-6803
Country : US
Telephone Number : 703-896-9999
Fax Number : 703-896-9998
Provider Business Practice Location Address
First Line : 1 BUCCANEER PL
Second Line :
City : TAMPA
State : FL
Zip : 33607-5701
Country : US
Telephone Number : 917-939-2022
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2015
Last Update Date : 04/16/2025

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Directions to “ MARAL JAVADIFAR DPT” Practice Location

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