Provider Demographics
NPI:1679144968
Name:SINGH, MANJEET (PT)
Entity type:Individual
Prefix:
First Name:MANJEET
Middle Name:
Last Name:SINGH
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 1:1569 AGATE CT
Mailing Address - Street 2:
Mailing Address - City:TYSONS CORNER
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3927
Mailing Address - Country:US
Mailing Address - Phone:609-271-6588
Mailing Address - Fax:
Practice Address - Street 1:1569 AGATE CT
Practice Address - Street 2:
Practice Address - City:TYSONS CORNER
Practice Address - State:VA
Practice Address - Zip Code:22102-3927
Practice Address - Country:US
Practice Address - Phone:609-271-6588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist