Provider Demographics
NPI:1679013619
Name:WASHATKA, JONATHAN (PT, DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:WASHATKA
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21620 RIDGETOP CIR
Mailing Address - Street 2:#180
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-4248
Mailing Address - Country:US
Mailing Address - Phone:703-406-0296
Mailing Address - Fax:
Practice Address - Street 1:21620 RIDGETOP CIR
Practice Address - Street 2:#180
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-4248
Practice Address - Country:US
Practice Address - Phone:703-406-0296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210883225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic