Provider Demographics
NPI:1184267643
Name:BALARAJU, VINAYA (PT)
Entity type:Individual
Prefix:
First Name:VINAYA
Middle Name:
Last Name:BALARAJU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9307 GLENBROOK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3054
Mailing Address - Country:US
Mailing Address - Phone:704-615-1122
Mailing Address - Fax:
Practice Address - Street 1:3050 MILITARY RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-1341
Practice Address - Country:US
Practice Address - Phone:202-596-3103
Practice Address - Fax:202-363-4699
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT871212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist