Basic Information
| Provider Information | |||||||||
| NPI: | 1265733554 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | USTARIS | ||||||||
| FirstName: | NANDINA | ||||||||
| MiddleName: | JINNOHARA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PT, DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JINNOHARA | ||||||||
| OtherFirstName: | NANDINA | ||||||||
| OtherMiddleName: | AI LING HOKULANI | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | PT, DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8348 TRAFORD LN | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221521663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036297759 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8348 TRAFORD LN | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221521663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035697335 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2010 | ||||||||
| LastUpdateDate: | 09/13/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305206676 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.