Provider Demographics
NPI:1942983002
Name:WASHINGTON, DMITRI
Entity Type:Individual
Prefix:
First Name:DMITRI
Middle Name:
Last Name:WASHINGTON
Suffix:
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 1:230 T C JESTER BLVD APT 141
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-3182
Mailing Address - Country:US
Mailing Address - Phone:623-217-8299
Mailing Address - Fax:
Practice Address - Street 1:23900 KATY FWY
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1323
Practice Address - Country:US
Practice Address - Phone:623-217-8299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist