Individual
JONATHAN MICHAEL WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
13298C BLUEBERRY LN APT 103, FAIRFAX, VA 22033-4864
(703) 993-8350
Mailing address
13298C BLUEBERRY LN APT 103, FAIRFAX, VA 22033-4864
(703) 993-8350
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
02/03/2026
Last updated
02/03/2026
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