Provider Demographics
NPI:1942592019
Name:SUNDERARAJAN, ANUSHA (MPT)
Entity Type:Individual
Prefix:
First Name:ANUSHA
Middle Name:
Last Name:SUNDERARAJAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19465 DEERFIELD AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1702
Mailing Address - Country:US
Mailing Address - Phone:703-723-4088
Mailing Address - Fax:
Practice Address - Street 1:19465 DEERFIELD AVE STE 108
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-1702
Practice Address - Country:US
Practice Address - Phone:703-723-4088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23581225100000X
VA23052078632251X0800X
DCPT871191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist