Provider Demographics
NPI:1194724252
Name:MOHARIR, CHARUTA (PT)
Entity type:Individual
Prefix:
First Name:CHARUTA
Middle Name:
Last Name:MOHARIR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 MAIN ST
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3907
Mailing Address - Country:US
Mailing Address - Phone:703-279-4394
Mailing Address - Fax:703-279-4214
Practice Address - Street 1:3600 JOSEPH SIEWICK DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1709
Practice Address - Country:US
Practice Address - Phone:703-391-3642
Practice Address - Fax:703-391-3455
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006353225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist