Basic Information
| Provider Information | |||||||||
| NPI: | 1578923165 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VANI | ||||||||
| FirstName: | NINA | ||||||||
| MiddleName: | SANJAY | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43629 WHITE CAP TER | ||||||||
| Address2: | |||||||||
| City: | CHANTILLY | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201525801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2022156089 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8320 OLD COURTHOUSE RD STE 401 | ||||||||
| Address2: | |||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038105214 | ||||||||
| FaxNumber: | 7038105494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2016 | ||||||||
| LastUpdateDate: | 06/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305210046 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.