Provider Demographics
NPI:1649412024
Name:AMBEGAONKAR, SHRUTI K (MPT)
Entity Type:Individual
Prefix:
First Name:SHRUTI
Middle Name:K
Last Name:AMBEGAONKAR
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:SHRUTI
Other - Middle Name:K
Other - Last Name:NAGARIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8551 RIXLEW LN STE 340
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-4278
Mailing Address - Country:US
Mailing Address - Phone:703-368-7343
Mailing Address - Fax:703-368-0719
Practice Address - Street 1:8551 RIXLEW LN STE 340
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-4278
Practice Address - Country:US
Practice Address - Phone:703-368-7343
Practice Address - Fax:703-368-0719
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist