Healthcare Provider Details

I. General information

NPI: 1003292640
Provider Name (Legal Business Name): PETER ZATEZALO DPT, OCS, COMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 S EDGEWOOD ST
ARLINGTON VA
22204-4813
US

IV. Provider business mailing address

2726 GALLOWS RD APT 804
VIENNA VA
22180-7149
US

V. Phone/Fax

Practice location:
  • Phone: 703-289-0389
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT200001383
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305209513
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number050291
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: