Jonathan Phuong

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2306605924 Issued in VA

Practice address

12825 Minnieville Rd Ste 201
Lake Ridge, VA 22192-3602

Phone

(703) 647-3130

NPI assigned

Jan 4, 2024

Last updated

Jan 4, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1704326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704326400000",
    "number": "1073383600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6654 ROCK ISLAND RD APT 100",
            "city": "SPRINGFIELD",
            "state": "VA",
            "postal_code": "221501974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12825 MINNIEVILLE RD STE 201",
            "city": "LAKE RIDGE",
            "state": "VA",
            "postal_code": "221923602",
            "telephone_number": "703-647-3130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHUONG",
        "first_name": "JONATHAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-04",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "VA",
            "license": "2306605924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patient First Richmond Medical Group (Patient First Lake Ridge)
• Patient First Richmond Medical Group PLLC (Patient First - Lake Ridge)
• Patriot Home Care Services, LLC
• Taryn Nichelle Pettigrew, OT
• Andrew Davis Pfaff, PA-C
• Potomac Hospital Corporation of Prince William (Lake Ridge)
• Donna L Price, LPC
• Jun Anthony V Quion, M.D. FACC
• Michelle Rainville
• Rehab Masters, Inc.

• Physical Therapy Assistant in Lake Ridge, VA
• Providers in Lake Ridge, VA by specialty
• Physical Therapy Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.