Roy A Etta, PT,DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

CP051278T Issued in VA

Practice address

42365 Soave Dr Ste 200
Brambleton, VA 20148-4888

Phone

(571) 349-3116

Fax

(571) 349-3119

NPI assigned

Nov 19, 2025

Last updated

Aug 27, 2026By 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 3

Addresses

Medicare fee-for-service enrollment

Enrolled in DC, VA2 enrollments

Enrollment records 2

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)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Jackson Clinics Limited Partnership

  • Physical Therapist
  • Centreville, VA
  • NPI 1639594831

  DC

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1763510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787788800000",
    "number": "1972464055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12701 FAIR LAKES CIR STE 102",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220334913",
            "telephone_number": "571-349-3116",
            "fax_number": "571-349-3119"
        },
        {
            "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",
            "fax_number": "571-349-3119"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 Sigman Rd NE Ste 220",
            "address_purpose": "LOCATION",
            "city": "Conyers",
            "state": "GA",
            "postal_code": "300123819",
            "country_code": "US",
            "telephone_number": "678-210-0311",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2801 N Decatur Rd Ste 230",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "GA",
            "postal_code": "300337430",
            "country_code": "US",
            "telephone_number": "404-294-7211",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4743 Atlanta Hwy Ste 100",
            "address_purpose": "LOCATION",
            "city": "Loganville",
            "state": "GA",
            "postal_code": "300522686",
            "country_code": "US",
            "telephone_number": "770-466-9343",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2400 Wisteria Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Snellville",
            "state": "GA",
            "postal_code": "300782689",
            "country_code": "US",
            "telephone_number": "770-982-0102",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETTA",
        "first_name": "ROY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PT,DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-11-19",
        "last_updated": "2026-08-27",
        "certification_date": "2026-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "CP060348T",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "16530",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "CP051278T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jack Thomas Duvall, DPT
• Morgan Eberle, DPT, PT
• Aysha Ehsan, DPT, PT
• Melvin Enderes, ATC
• Davion E Enders-Jones, DPT, PT
• Fairfax Family Practice Centers PC (Broadlands Family Practice at Brambleton)
• Flexcare Physical Therapy LLC
• Benjamin Daniel Fox, M.D.
• Ioanna Gisone, PH.D.
• Jenna Goffe, FNP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2026; 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.