Provider Demographics
NPI:1063442630
Name:ALMQUIST, JON (ATC)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:
Last Name:ALMQUIST
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10627 HUNTERS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-3019
Mailing Address - Country:US
Mailing Address - Phone:703-255-7163
Mailing Address - Fax:571-423-1267
Practice Address - Street 1:8115 GATEHOUSE RD
Practice Address - Street 2:SUITE 5100
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-1203
Practice Address - Country:US
Practice Address - Phone:571-423-1264
Practice Address - Fax:571-423-1267
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260001552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer