Active NPI
Alfredo Besavilla Pantino Jr
- Physical Therapist
- Woodbridge, VA
National Provider Identifier
1336479955
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2305006480
- Practice address
- 15533 John Diskin Cir
Woodbridge, VA 22191-6378 - Phone
- (571) 275-1330
- NPI assigned
- Jan 4, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2305006480 | VA | Primary |
Addresses
Primary practice location
15533 John Diskin Cir
Woodbridge, VA 22191-6378
Mailing address
15533 John Diskin Cir
Woodbridge, VA 22191-6378
Phone (571) 275-1330
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2305006480 | VA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1262563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1262563200000",
"number": "1336479955",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15533 JOHN DISKIN CIR",
"city": "WOODBRIDGE",
"state": "VA",
"postal_code": "221916378",
"telephone_number": "571-275-1330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15533 JOHN DISKIN CIR",
"city": "WOODBRIDGE",
"state": "VA",
"postal_code": "221916378",
"telephone_number": "571-275-1330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANTINO JR",
"first_name": "ALFREDO",
"middle_name": "BESAVILLA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-01-04",
"last_updated": "2010-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "VA",
"license": "2305006480",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbridge, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.