Individual
MARY DEBOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
6408 GROVEDALE DRIVE, SUITE 102, ALEXANDRIA, VA 22310-2596
(703) 884-8490
Mailing address
224-D CORNWALL STREET, NW, SUITE 403, LEESBURG, VA 20176-2704
(703) 737-6010
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305216481
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30017889730001
—
VA
Enumeration date
05/29/2024
Last updated
09/16/2024
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