Provider Demographics
NPI:1073226825
Name:NOVA PRIME PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:NOVA PRIME PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHITAL
Authorized Official - Middle Name:KANAIYALAL
Authorized Official - Last Name:GANDHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-317-8896
Mailing Address - Street 1:PO BOX 222092
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20153-2092
Mailing Address - Country:US
Mailing Address - Phone:571-774-6378
Mailing Address - Fax:
Practice Address - Street 1:13995 METROTECH DR
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-3240
Practice Address - Country:US
Practice Address - Phone:571-774-6378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-26
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty