Katerina Dabolt, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305210220 Issued in VA

Practice address

11200 Waples Mill Rd Ste 100
Fairfax, VA 22030-7475

Phone

(703) 237-2219

NPI assigned

Aug 16, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Katerina Prusova, Meade Former name

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• In-Home Physical Therapy and Wellness LLC

  • Physical Therapist
  • Annandale, VA
  • NPI 1659085371

  DC

  Medicare reassignment NPD Authorized official
• Axiom Link, Inc.

  dba Achieve Beyond

  • Rehabilitation Clinic/Center
  • Fairfax, VA
  • NPI 1174852867
  NPD (past)

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

{
    "created_epoch": "1187222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585785600000",
    "number": "1851583470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9006 WINDFLOWER LN",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220034057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11200 WAPLES MILL RD STE 100",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220307475",
            "telephone_number": "703-237-2219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DABOLT",
        "first_name": "KATERINA",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-16",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "33744",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305210220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATERINA",
            "last_name": "PRUSOVA, MEADE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lorna Lynn Cvetkovich, M.D.
• Frank E Czwalga, RPH
• Kaitlyn D'Andrea
• Sarah D'Elia
• Lymaraina D'Souza, LPC
• Taylor Dacosta
• Aysha Dada, PA-C
• Sara Tayefeh Dada
• Katherine Theresa Daddis, MS OTR/L
• Rodney B Dade, MD

• Physical Therapist in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.