Provider Demographics
NPI:1184313074
Name:BAHRAMIAN, MEHRDAD (PT)
Entity type:Individual
Prefix:
First Name:MEHRDAD
Middle Name:
Last Name:BAHRAMIAN
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 1:5095 SAVANNAH RUN
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-0281
Mailing Address - Country:US
Mailing Address - Phone:470-628-3419
Mailing Address - Fax:
Practice Address - Street 1:24560 SOUTHPOINT DR STE 250
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-3504
Practice Address - Country:US
Practice Address - Phone:571-370-3686
Practice Address - Fax:571-370-3687
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACP029380T225100000X
MD29413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist