Provider Demographics
NPI:1184964108
Name:MIRSHAHI, ROYA KORDI (DPT)
Entity type:Individual
Prefix:
First Name:ROYA
Middle Name:KORDI
Last Name:MIRSHAHI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12417 LYNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7121
Mailing Address - Country:US
Mailing Address - Phone:804-360-3947
Mailing Address - Fax:
Practice Address - Street 1:320 CHARLES DIMMOCK PARKWAY, SUITE 6
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834
Practice Address - Country:US
Practice Address - Phone:804-524-0533
Practice Address - Fax:804-524-0133
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist