Provider Demographics
NPI:1255037495
Name:RUZANSKI, JACOB W (DPT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:W
Last Name:RUZANSKI
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:PO BOX 1769
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20118-1769
Mailing Address - Country:US
Mailing Address - Phone:703-299-6688
Mailing Address - Fax:
Practice Address - Street 1:209 MADISON ST STE LL
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2065
Practice Address - Country:US
Practice Address - Phone:703-299-6688
Practice Address - Fax:703-299-3588
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist