Provider Demographics
NPI:1174296370
Name:JAMOKHA, DANIEL ZIAD (DPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ZIAD
Last Name:JAMOKHA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 KING ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1905
Mailing Address - Country:US
Mailing Address - Phone:714-742-8170
Mailing Address - Fax:
Practice Address - Street 1:5100 FILLMORE AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-5069
Practice Address - Country:US
Practice Address - Phone:703-291-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214249225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist