Provider Demographics
NPI:1093207144
Name:MOJTAHEDI, NILOUFAR (PT)
Entity Type:Individual
Prefix:MRS
First Name:NILOUFAR
Middle Name:
Last Name:MOJTAHEDI
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 1:2340 MILLENNIUM LN
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-2956
Mailing Address - Country:US
Mailing Address - Phone:571-344-9886
Mailing Address - Fax:
Practice Address - Street 1:2340 MILLENNIUM LN
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-2956
Practice Address - Country:US
Practice Address - Phone:571-344-9886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211836225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist