Individual
JASON TODD DERTING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
140 BRIMLEY ROAD, FREDERICKSBURG, VA 22406
(540) 752-0111
Mailing address
6801 ORCHID LN, FREDERICKSBURG, VA 22407-8502
(540) 419-7410
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306602034
VA
Other
Enumeration date
12/03/2010
Last updated
12/03/2010
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