Provider Demographics
NPI:1528243037
Name:PATIL, TRUPTI (PT)
Entity type:Individual
Prefix:MS
First Name:TRUPTI
Middle Name:
Last Name:PATIL
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 1:1911 KENNEDY DR
Mailing Address - Street 2:203
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4779
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6940 BRADDOCK RD
Practice Address - Street 2:A
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-6036
Practice Address - Country:US
Practice Address - Phone:703-333-5022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205154225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist