Mason Wallace

NPI 1033500525 - Physical Therapist - 225100000X

NPI Details
NPI 1033500525
Gender Male
Enumeration Date 02/05/2015
Last Updated 02/05/2015
Entity Type Individual
Active Over 1 year ago
Practice Location
209 MADISON ST
SUITE LL2
ALEXANDRIA VA, 22314-1764, US
Phone (703) 299-6688
Fax (703) 299-3588
Business Location
209 MADISON ST
SUITE LL2
ALEXANDRIA VA, 22314-1764, US
Phone (703) 299-6688
Fax (703) 299-3588
Toxanomy
Taxonomy Code 225100000X
License State Virginia
License Number 2305209278
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According to our database, Mason Wallace NPI is 1033500525, taxonomy code is 225100000X and license number is 2305209278, license state is located at Virginia. Mason Wallace physically located at 209 Madison St, Alexandria VA, 22314-1764. NPI Number Mason Wallace has the Individual type.

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1033500525 NPI number is provided on an as is basis without warranty of any kind. 1033500525 is maintained by the National Plan & Provider Enumeration System. The contents of Mason Wallace are for informational purposes only.