Provider Demographics
NPI:1154809077
Name:GOORAH, KEERTI (DPT)
Entity type:Individual
Prefix:DR
First Name:KEERTI
Middle Name:
Last Name:GOORAH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13082 AUTUMN WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-8202
Mailing Address - Country:US
Mailing Address - Phone:678-447-5754
Mailing Address - Fax:
Practice Address - Street 1:13082 AUTUMN WILLOW DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-8202
Practice Address - Country:US
Practice Address - Phone:678-447-5754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212178225100000X, 261QP2000X, 2251P0200X
OK5769225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy