Provider Demographics
NPI:1295068013
Name:ZGONC, MICHELLE LEIGH (PT, DPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEIGH
Last Name:ZGONC
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ZGONC
Other - Last Name:PARISE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:3815 FORT WORTH AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1708
Mailing Address - Country:US
Mailing Address - Phone:914-318-2289
Mailing Address - Fax:
Practice Address - Street 1:2301 COLUMBIA PIKE APT 125
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-4453
Practice Address - Country:US
Practice Address - Phone:202-544-5439
Practice Address - Fax:202-379-1797
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC64692251P0200X
DCPT200013952251P0200X
NY031583-12251P0200X
WAPT.PT.604081542251P0200X
VA23052111792251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics