Provider Demographics
NPI:1548323272
Name:PANDYA CHANG, VIRAJ (PT)
Entity type:Individual
Prefix:
First Name:VIRAJ
Middle Name:
Last Name:PANDYA CHANG
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 1:44927 GEORGE WASHINGTON BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4292
Mailing Address - Country:US
Mailing Address - Phone:571-291-9936
Mailing Address - Fax:
Practice Address - Street 1:44927 GEORGE WASHINGTON BLVD STE 210
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4292
Practice Address - Country:US
Practice Address - Phone:571-291-9936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-17
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21244225100000X
VA2305205580225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist