Healthcare Provider Details

I. General information

NPI: 1295068013
Provider Name (Legal Business Name): MICHELLE LEIGH ZGONC PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE ZGONC PARISE PT, DPT

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 08/08/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 COLUMBIA PIKE APT 125
ARLINGTON VA
22204-4453
US

IV. Provider business mailing address

3815 FORT WORTH AVE
ALEXANDRIA VA
22304-1708
US

V. Phone/Fax

Practice location:
  • Phone: 202-544-5439
  • Fax: 202-379-1797
Mailing address:
  • Phone: 914-318-2289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number6469
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT20001395
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number031583-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT.PT.60408154
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305211179
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: