Provider Demographics
NPI:1457191868
Name:BAT-ERDENE, ERDENESHAGAI (DPT)
Entity type:Individual
Prefix:
First Name:ERDENESHAGAI
Middle Name:
Last Name:BAT-ERDENE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:ERIC
Other - Middle Name:
Other - Last Name:BAT-ERDENE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:14348 GIDEON DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4640
Mailing Address - Country:US
Mailing Address - Phone:703-490-1112
Mailing Address - Fax:703-878-8732
Practice Address - Street 1:14348 GIDEON DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4640
Practice Address - Country:US
Practice Address - Phone:703-490-1112
Practice Address - Fax:703-878-8732
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist