NPIMap

Organization Active NPI

Pelvic Pro Physical Therapy LLC

  • Physical Therapist
  • Fairfax, VA
National Provider Identifier
1649017724
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PELVIC PRO PHYSICAL THERAPY LLC
Practice address
4026 Colonel Mendez Way
Fairfax, VA 22032-1062
Phone
(732) 213-3401
NPI assigned
Jul 15, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Grishma Shah, DPTNPI 1023323326
Title
Clinic Director
Phone
(732) 213-3401

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

4026 Colonel Mendez Way
Fairfax, VA 22032-1062

Mailing address

4026 Colonel Mendez Way
Fairfax, VA 22032-1062
Phone (732) 213-3401

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721001600000",
    "number": "1649017724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4026 COLONEL MENDEZ WAY",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220321062",
            "telephone_number": "732-213-3401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4026 COLONEL MENDEZ WAY",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220321062",
            "telephone_number": "732-213-3401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PELVIC PRO PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-15",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "GRISHMA",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "732-213-3401",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "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 Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.