Provider Demographics
NPI:1407364268
Name:NAZARI, PANTEHA (PT, DPT, BCB-PMD)
Entity Type:Individual
Prefix:DR
First Name:PANTEHA
Middle Name:
Last Name:NAZARI
Suffix:
Gender:F
Credentials:PT, DPT, BCB-PMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 PROSPERITY AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4340
Mailing Address - Country:US
Mailing Address - Phone:703-291-3082
Mailing Address - Fax:703-291-3083
Practice Address - Street 1:2700 PROSPERITY AVE STE 260
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4340
Practice Address - Country:US
Practice Address - Phone:703-291-3082
Practice Address - Fax:703-291-3083
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005082261QP2000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty