Healthcare Provider Details

I. General information

NPI: 1407142482
Provider Name (Legal Business Name): JUSTIN T DIMITT DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 PANTOPS MOUNTAIN PL
CHARLOTTESVILLE VA
22911-4671
US

IV. Provider business mailing address

PO BOX 412307
BOSTON MA
02241-2307
US

V. Phone/Fax

Practice location:
  • Phone: 434-817-4100
  • Fax: 434-817-4101
Mailing address:
  • Phone: 914-294-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305206949
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: