Individual
HY IA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
13590 RICHMOND HWY # 1, WOODBRIDGE, VA 22191-1218
(703) 492-5050
Mailing address
13590 RICHMOND HWY # 1, WOODBRIDGE, VA 22191-1218
(703) 492-5050
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305216217
VA
225100000X
Physical Therapist
PT298478
CA
Other
Enumeration date
10/26/2020
Last updated
03/20/2024
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