Provider Demographics
NPI:1629287511
Name:GANDY, JODY SHAPIRO (PT, PHD)
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:SHAPIRO
Last Name:GANDY
Suffix:
Gender:F
Credentials:PT, PHD
Other - Prefix:MS
Other - First Name:JODY
Other - Middle Name:A
Other - Last Name:SHAPIRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, PHD
Mailing Address - Street 1:2409 ALTENBURG CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-3205
Mailing Address - Country:US
Mailing Address - Phone:301-374-6985
Mailing Address - Fax:301-374-6985
Practice Address - Street 1:1111 NORTH FAIRFAX STREET
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1488
Practice Address - Country:US
Practice Address - Phone:703-706-3201
Practice Address - Fax:703-706-3387
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT 000982-E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist