Individual
JASON GOODBRAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CMT, SI
Contact information
Practice address
1485 CHAIN BRIDGE RD STE 101, MC LEAN, VA 22101-4513
(334) 301-2710
Mailing address
1485 CHAIN BRIDGE RD STE 101, MC LEAN, VA 22101-4513
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0019007563
VA
Other
Enumeration date
11/16/2015
Last updated
11/16/2015
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