Individual
MR. CHARLES EDWARD MACK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT, PT
Contact information
Practice address
24560 SOUTHPOINT DR STE 250, ALDIE, VA 20105-3504
(571) 370-3686
(571) 370-3687
Mailing address
12701 FAIR LAKES CIR STE 102, FAIRFAX, VA 22033-4913
(571) 370-3686
(571) 370-3687
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305211409
VA
Other
Enumeration date
08/07/2017
Last updated
05/11/2026
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