Provider Demographics
NPI:1912548629
Name:MASSUMI, CAMERON JOHN (PT, DPT, CMPTPT)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:JOHN
Last Name:MASSUMI
Suffix:
Gender:M
Credentials:PT, DPT, CMPTPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46558 BROADSPEAR TER
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165
Mailing Address - Country:US
Mailing Address - Phone:703-828-0582
Mailing Address - Fax:
Practice Address - Street 1:46558 BROADSPEAR TER
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-3217
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28089225100000X
VA2305213180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty