Provider Demographics
NPI:1598469215
Name:GILL, SARBJEET S (PTA)
Entity Type:Individual
Prefix:
First Name:SARBJEET
Middle Name:S
Last Name:GILL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46152 AISQUITH TER
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-8726
Mailing Address - Country:US
Mailing Address - Phone:571-286-8789
Mailing Address - Fax:
Practice Address - Street 1:171 ELDEN ST STE 140
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4834
Practice Address - Country:US
Practice Address - Phone:703-866-6323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306605100225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2306605100OtherLICENSE