Provider Demographics
NPI:1710388228
Name:SHAKYA REHAB LLC
Entity Type:Organization
Organization Name:SHAKYA REHAB LLC
Other - Org Name:MMA & SPORTS REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:UJJWAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKYA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:571-315-2637
Mailing Address - Street 1:6714 WESTCOTT RD
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-2718
Mailing Address - Country:US
Mailing Address - Phone:571-315-2637
Mailing Address - Fax:
Practice Address - Street 1:1041 S EDGEWOOD ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-4813
Practice Address - Country:US
Practice Address - Phone:571-315-2637
Practice Address - Fax:703-521-0373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty