Provider Demographics
NPI:1689198293
Name:DIGIOVANNI, JOHN GABRIEL JR
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GABRIEL
Last Name:DIGIOVANNI
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 HORSEPEN MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:VA
Mailing Address - Zip Code:24179-1128
Mailing Address - Country:US
Mailing Address - Phone:540-588-8550
Mailing Address - Fax:
Practice Address - Street 1:4060 HORSEPEN MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-1128
Practice Address - Country:US
Practice Address - Phone:540-588-8550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306604782225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant