Individual
MADDISON LEA MCQUILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT, PT
Contact information
Practice address
13039 WORLDGATE DR, HERNDON, VA 20170-4374
(703) 689-3164
(703) 689-3167
Mailing address
PO BOX 1769, MIDDLEBURG, VA 20118-1769
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305212491
VA
Other
Enumeration date
11/04/2018
Last updated
12/10/2019
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