Provider Demographics
NPI:1245773373
Name:NAIR, ANISH (MS PT)
Entity Type:Individual
Prefix:
First Name:ANISH
Middle Name:
Last Name:NAIR
Suffix:
Gender:M
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 BEVERLY RD STE 210
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3736
Mailing Address - Country:US
Mailing Address - Phone:703-288-8260
Mailing Address - Fax:703-288-9316
Practice Address - Street 1:1420 BEVERLY RD STE 210
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3736
Practice Address - Country:US
Practice Address - Phone:703-288-8260
Practice Address - Fax:703-288-9316
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26192225100000X
VA2305213748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1447657507OtherNPI TYPE 2/ ORGANIZATION
MD4374045-00Medicaid
MD337361, 337362Medicare PIN