Provider Demographics
NPI:1538655972
Name:PUNTIKURA, VIPULA (PHYSICAL THERAPIST A)
Entity Type:Individual
Prefix:
First Name:VIPULA
Middle Name:
Last Name:PUNTIKURA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9672 CEDAR FARM CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5404
Mailing Address - Country:US
Mailing Address - Phone:571-337-6687
Mailing Address - Fax:
Practice Address - Street 1:12475 LEE JACKSON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2803
Practice Address - Country:US
Practice Address - Phone:571-337-6687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306604030225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant