Provider Demographics
NPI:1144558768
Name:JAIN, NEHAL (DPT)
Entity type:Individual
Prefix:
First Name:NEHAL
Middle Name:
Last Name:JAIN
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 1:9806 GABLE RIDGE TER
Mailing Address - Street 2:APT L
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4662
Mailing Address - Country:US
Mailing Address - Phone:516-398-1676
Mailing Address - Fax:
Practice Address - Street 1:44055 RIVERSIDE PKWY
Practice Address - Street 2:118
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-5179
Practice Address - Country:US
Practice Address - Phone:703-858-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23060225100000X
VA2305204705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist