Provider Demographics
NPI:1780702373
Name:CHARAIPOTRA, PUJA SURESH (PT)
Entity type:Individual
Prefix:MRS
First Name:PUJA
Middle Name:SURESH
Last Name:CHARAIPOTRA
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 1:10881 MIMOSA PL
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2427
Mailing Address - Country:US
Mailing Address - Phone:703-268-5585
Mailing Address - Fax:
Practice Address - Street 1:6849 OLD DOMINION DR
Practice Address - Street 2:SUITE 221
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3724
Practice Address - Country:US
Practice Address - Phone:703-848-9333
Practice Address - Fax:703-848-0660
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052021942251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00B375P03Medicare ID - Type Unspecified