# POTOMAC PHYSICAL MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Potomac Physical Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538552781
- **Authorized official:** MATTHEW FONTAINE DC (DOCTOR/OWNER)
- **Authorized official phone:** (571) 982-3354

## Contact information

- **Practice address:** 113 N HENRY ST, ALEXANDRIA, VA 22314-2903
- **Practice address phone:** (571) 234-9319
- **Mailing address:** 113 N HENRY, ALEXANDRIA, VA 22314
- **Mailing address phone:** (571) 982-3354

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 0104556931 | VA | Yes |

## Other

- **Enumeration date:** 03/12/2015
- **Last updated:** 01/06/2023