Provider Demographics
NPI:1033627898
Name:MISRA, ANSHUL
Entity Type:Individual
Prefix:
First Name:ANSHUL
Middle Name:
Last Name:MISRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANSHUL
Other - Middle Name:
Other - Last Name:SHARMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 PIDGEON HILL DR
Mailing Address - Street 2:STE 103
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-6134
Mailing Address - Country:US
Mailing Address - Phone:571-313-0929
Mailing Address - Fax:571-313-8270
Practice Address - Street 1:20 PIDGEON HILL DR STE 103
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-6134
Practice Address - Country:US
Practice Address - Phone:571-313-0929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-15
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210886225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist