Healthcare Provider Details

I. General information

NPI: 1699682682
Provider Name (Legal Business Name): JOSE DAMIAN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4299 CHANTILLY SHOPPING CENTER DR STE 104
CHANTILLY VA
20151-4025
US

IV. Provider business mailing address

24751 PENFIELD ST
LAKE FOREST CA
92630-5261
US

V. Phone/Fax

Practice location:
  • Phone: 703-844-0690
  • Fax: 703-782-9379
Mailing address:
  • Phone: 949-309-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217989
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: