Healthcare Provider Details

I. General information

NPI: 1316586605
Provider Name (Legal Business Name): DOMINICK VILSAINT DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 HAMAKER CT STE 100
FAIRFAX VA
22031-2233
US

IV. Provider business mailing address

11597 217TH ST
CAMBRIA HEIGHTS NY
11411-1137
US

V. Phone/Fax

Practice location:
  • Phone: 703-844-8599
  • Fax: 703-844-8594
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305213081
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number045005
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number29548
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: