Provider Demographics
NPI:1447731419
Name:DUTT, ARJUN (PT , MPT , DPT)
Entity type:Individual
Prefix:
First Name:ARJUN
Middle Name:
Last Name:DUTT
Suffix:
Gender:M
Credentials:PT , MPT , DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 BERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-2207
Mailing Address - Country:US
Mailing Address - Phone:909-653-6648
Mailing Address - Fax:
Practice Address - Street 1:621 BERRY HILL RD
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-2207
Practice Address - Country:US
Practice Address - Phone:909-653-6648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist