Individual
THERESA BENTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8500 EXECUTIVE PARK AVE STE 300, FAIRFAX, VA 22031-2228
(703) 698-7117
Mailing address
4518 SAMUELS PINE RD, CHANTILLY, VA 20151-1419
(703) 826-1525
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0019018874
VA
Other
Enumeration date
08/30/2022
Last updated
08/30/2022
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