Active NPI
Keerti Goorah, DPT
- Pediatric Physical Therapist
- Fairfax, VA
National Provider Identifier
1154809077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 2305212178
- Practice address
- 13082 Autumn Willow Dr
Fairfax, VA 22030-8202 - Phone
- (678) 447-5754
- NPI assigned
- Aug 2, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2305212178 | VA | |
| Physical Therapist | 225100000X | 5769 | OK | |
| Physical Therapy Clinic/Center | 261QP2000X | 2305212178 | VA | |
| Pediatric Physical Therapist | 2251P0200X | 2305212178 | VA | Primary |
Addresses
Primary practice location
13082 Autumn Willow Dr
Fairfax, VA 22030-8202
Mailing address
13082 Autumn Willow Dr
Fairfax, VA 22030-8202
Phone (678) 447-5754
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2305212178 | VA | MD | Physical Therapy Clinic/Center |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wild Ones Physical Therapy, LLC | Physical Therapist | Current | Accepting new patients |
| Fleming Therapy Services, LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Falls Church, VA
- NPI 1689501058
-
- Speech-Language Pathologist
- Stafford, VA
- NPI 1194925818
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693267200000",
"number": "1154809077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13082 AUTUMN WILLOW DR",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220308202",
"telephone_number": "678-447-5754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13082 AUTUMN WILLOW DR",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220308202",
"telephone_number": "678-447-5754"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOORAH",
"first_name": "KEERTI",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-08-02",
"last_updated": "2023-08-29",
"certification_date": "2023-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "VA",
"license": "2305212178",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OK",
"license": "5769",
"primary": false
},
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": "VA",
"license": "2305212178",
"primary": false
},
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "VA",
"license": "2305212178",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.