Provider Demographics
NPI:1306801857
Name:DOMBEK, ANDREW IAN (MSPT)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:IAN
Last Name:DOMBEK
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20925 PROFESSIONAL PLZ STE 110
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3403
Mailing Address - Country:US
Mailing Address - Phone:703-723-6758
Mailing Address - Fax:703-723-6759
Practice Address - Street 1:20925 PROFESSIONAL PLZ STE 110
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3403
Practice Address - Country:US
Practice Address - Phone:703-723-6758
Practice Address - Fax:703-723-6759
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA030606449OtherTAX IDENTIFICATION
VA00X247A01Medicare PIN