Provider Demographics
NPI:1407142482
Name:DIMITT, JUSTIN THOMAS (DPT)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:THOMAS
Last Name:DIMITT
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 1:38 EBCO CIR STE 106
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-7344
Mailing Address - Country:US
Mailing Address - Phone:540-490-0308
Mailing Address - Fax:540-451-7064
Practice Address - Street 1:38 EBCO CIR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-7344
Practice Address - Country:US
Practice Address - Phone:540-490-0308
Practice Address - Fax:540-451-7064
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206949225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1407142482Medicaid