Provider Demographics
NPI:1154379303
Name:GURJAR, MADHURA A (PT)
Entity type:Individual
Prefix:
First Name:MADHURA
Middle Name:A
Last Name:GURJAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MADHURA
Other - Middle Name:
Other - Last Name:ASANARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 2901
Mailing Address - Street 2:
Mailing Address - City:MERRIFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22116-2901
Mailing Address - Country:US
Mailing Address - Phone:703-646-2250
Mailing Address - Fax:703-991-5649
Practice Address - Street 1:2841 HARTLAND RD STE 403
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-3500
Practice Address - Country:US
Practice Address - Phone:703-646-2250
Practice Address - Fax:703-991-5649
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT870994225100000X
MI551012801225100000X
VA2305205819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30016439670001Medicaid
VA2307001242OtherDIRECT ACCESS CERTIFICATION
VACA96-0000OtherCAREFIRST