Provider Demographics
NPI:1174896278
Name:ANGARA, GAYATRI
Entity type:Individual
Prefix:MS
First Name:GAYATRI
Middle Name:
Last Name:ANGARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 CAMERON GLEN DR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3308
Mailing Address - Country:US
Mailing Address - Phone:434-603-0043
Mailing Address - Fax:
Practice Address - Street 1:1800 CAMERON GLEN DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3308
Practice Address - Country:US
Practice Address - Phone:434-603-0043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206206225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist