Individual
MASON WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
209 MADISON ST, SUITE LL2, ALEXANDRIA, VA 22314-1764
(703) 299-6688
(703) 299-3588
Mailing address
209 MADISON ST, SUITE LL2, ALEXANDRIA, VA 22314-1764
(703) 299-6688
(703) 299-3588
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305209278
VA
Other
Enumeration date
02/05/2015
Last updated
02/05/2015
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