Healthcare Provider Details

I. General information

NPI: 1770369506
Provider Name (Legal Business Name): JONATHON DIGNAZIO PT, DPT, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21300 COACH GIBBS DR
ASHBURN VA
20147-6323
US

IV. Provider business mailing address

21300 COACH GIBBS DR
ASHBURN VA
20147-6323
US

V. Phone/Fax

Practice location:
  • Phone: 281-635-6263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217835
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126004493
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: