Basic Information
| Provider Information | |||||||||
| NPI: | 1508406703 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALANSARI | ||||||||
| FirstName: | MOHAMMAD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8869 OLIVE MAE CIR | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220311479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2408888101 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4630 STONECROFT BLVD | ||||||||
| Address2: | |||||||||
| City: | CHANTILLY | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201511745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037342889 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2020 | ||||||||
| LastUpdateDate: | 01/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305213262 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.