MEDICARE: ANULEKHA MOMIN PT

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
1	225100000X	Physical Therapist	2305204898	VA

General Provider Information

NPI Number	:	1790837565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANULEKHA MOMIN PT

Provider Business Mailing Address
First Line	:	11240 WAPLES MILL RD
Second Line	:	SUITE 403
City	:	FAIRFAX
State	:	VA
Zip	:	22030-6078
Country	:	US
Telephone Number	:	703-383-6454
Fax Number	:	703-810-5494

Provider Business Practice Location Address
First Line	:	13350 FRANKLIN FARM RD
Second Line	:	SUITE 300
City	:	HERNDON
State	:	VA
Zip	:	20171-4091
Country	:	US
Telephone Number	:	703-810-5205
Fax Number	:	703-810-5494

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	10/30/2020

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