Organization
OMNI WELLNESS & PERFORMANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSE CHACON PTA (OWNER)
(703) 989-6014
Entity
Organization
Contact information
Practice address
5589 GUINEA RD, FAIRFAX, VA 22032-4052
(703) 989-6014
Mailing address
5589 GUINEA RD, FAIRFAX, VA 22032-4052
(703) 989-6014
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
01/16/2021
Last updated
01/16/2021
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