Provider Demographics
NPI:1649326836
Name:MATHEW, BOBBY RANJIT (PT)
Entity type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:RANJIT
Last Name:MATHEW
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 WESTMORELAND ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-1768
Mailing Address - Country:US
Mailing Address - Phone:703-940-3795
Mailing Address - Fax:
Practice Address - Street 1:2030 WESTMORELAND ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-1768
Practice Address - Country:US
Practice Address - Phone:703-940-3795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2019-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist