Provider Demographics
NPI:1790356004
Name:CHUDASAMA, AVIRAJSINH (DPT)
Entity Type:Individual
Prefix:
First Name:AVIRAJSINH
Middle Name:
Last Name:CHUDASAMA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:AVI
Other - Middle Name:
Other - Last Name:CHUDASAMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3620 JOSEPH SIEWICK DRIVE
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1757
Mailing Address - Country:US
Mailing Address - Phone:703-810-5227
Mailing Address - Fax:
Practice Address - Street 1:3620 JOSEPH SIEWICK DR STE 100
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1757
Practice Address - Country:US
Practice Address - Phone:703-277-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist