Provider Demographics
NPI:1154012565
Name:VELIZ, DOMINIC (DPT, PT)
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:
Last Name:VELIZ
Suffix:
Gender:M
Credentials:DPT, PT
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 LL2
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:2023-05-17
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216364225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist