Provider Demographics
NPI:1205184967
Name:LOHABARE, PANKAJKUMAR (PT)
Entity Type:Individual
Prefix:
First Name:PANKAJKUMAR
Middle Name:
Last Name:LOHABARE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8316 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5207
Mailing Address - Country:US
Mailing Address - Phone:703-560-3190
Mailing Address - Fax:703-560-3194
Practice Address - Street 1:9135 PISCATAWAY RD
Practice Address - Street 2:SUITE 305
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2549
Practice Address - Country:US
Practice Address - Phone:301-877-2323
Practice Address - Fax:301-877-2366
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD23963225100000X
VA2305207332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist