Individual
FREDERIC WIXSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSPT, GCS
Contact information
Practice address
417 E WINDSOR AVE, ALEXANDRIA, VA 22301-1227
(703) 739-8244
Mailing address
417 E WINDSOR AVE, ALEXANDRIA, VA 22301-1227
(703) 739-8244
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
2305005410
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000
NONE
VA
Enumeration date
12/17/2019
Last updated
04/06/2020
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