Provider Demographics
NPI:1265733554
Name:USTARIS, NANDINA JINNOHARA (PT, DPT)
Entity type:Individual
Prefix:
First Name:NANDINA
Middle Name:JINNOHARA
Last Name:USTARIS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:NANDINA
Other - Middle Name:AI LING HOKULANI
Other - Last Name:JINNOHARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:8348 TRAFORD LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1663
Mailing Address - Country:US
Mailing Address - Phone:703-629-7759
Mailing Address - Fax:
Practice Address - Street 1:8348 TRAFORD LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1663
Practice Address - Country:US
Practice Address - Phone:703-569-7335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist