Individual provider Active NPI

Jack Thomas Duvall, DPT

  • Physical Therapist
  • Brambleton, VA
National Provider Identifier
1053101345
Registry record updated May 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
42365 Soave Dr Ste 200
Brambleton, VA 20148-4888
Phone
(571) 349-3116
NPI assigned
May 9, 2025
Last updated
May 9, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X VA Primary

Addresses

Primary practice location

42365 Soave Dr Ste 200
Brambleton, VA 20148-4888

Mailing address

42365 Soave Dr Ste 200
Brambleton, VA 20148-4888
Phone (571) 349-3116

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250519000838 DC Practitioner - Physical Therapist in Private Practice 0648798199 Reassigns benefits to 1 organization
I20250521000501 VA Practitioner - Physical Therapist in Private Practice 0648798199 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jackson Clinics Limited PartnershipGroup PAC ID 2860623295, 116 clinicians

Practice addresses (Care Compare)

209 Madison St
Suite LL2
Alexandria, VA 22314-2065
Phone (703) 299-6688

42365 Soave Dr
Suite 200
Brambleton, VA 20148-4888
Phone (571) 349-3116

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson Clinics Limited Partnership Physical Therapist CurrentSince May 30, 2025 Accepting new patients
The Jackson Clinics LLC Physical Therapist PastSince May 30, 2025 Accepting new patients

Locations

209 Madison St
Ste LL2
Alexandria, VA 22314
Phone (703) 299-6688

43490 Yukon Dr
Ashburn, VA 20147
Phone (703) 729-7920

42365 Soave Dr
Ste 200
Brambleton, VA 20148
Phone (571) 349-3116

12701 Fair Lakes Cir
Ste 102
Fairfax, VA 22033

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1746748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746748800000",
    "number": "1053101345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42365 SOAVE DR STE 200",
            "city": "BRAMBLETON",
            "state": "VA",
            "postal_code": "201484888",
            "telephone_number": "571-349-3116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42365 SOAVE DR STE 200",
            "city": "BRAMBLETON",
            "state": "VA",
            "postal_code": "201484888",
            "telephone_number": "571-349-3116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUVALL",
        "first_name": "JACK",
        "middle_name": "THOMAS",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-05-09",
        "last_updated": "2025-05-09",
        "certification_date": "2025-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brambleton, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.