| Tanaz Falahatpour, | |
|
25370 Eastern Marketplace Plz Ste 120, South Riding, VA 20152-1428 | |
| (571) 339-3150 | |
| Not Available |
| Full Name | Tanaz Falahatpour |
|---|---|
| Gender | Female |
| Speciality | Physical Therapist |
| Location | 25370 Eastern Marketplace Plz Ste 120, South Riding, Virginia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841075496 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | 2305216070 (Virginia) | Primary |
| Provider Name | Professional Sportscare & Rehab Llc |
|---|---|
| Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
| Provider Identifiers | NPI Number: 1033142294 PECOS PAC ID: 9335137363 Enrollment ID: O20160418000007 |
| Mailing Address | Practice Location Address |
|---|---|
| Tanaz Falahatpour, 42435 Iron Bit Pl, Chantilly, VA 20152-6405 Ph: (703) 470-7146 | Tanaz Falahatpour, 25370 Eastern Marketplace Plz Ste 120, South Riding, VA 20152-1428 Ph: (571) 339-3150 |
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