Individual
MARY DISALVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICAL THERAPIST
Contact information
Practice address
600 JACKSON ST, FREDERICKSBURG, VA 22401
(540) 373-3223
Mailing address
630 LANCASTER ST, FREDERICKSBURG, VA 22405
(540) 373-6555
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305002506
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
192573
ANTHEM HEALTHKEEP PLUS
VA
01
—
229139
MDIPA
VA
Enumeration date
10/02/2006
Last updated
07/09/2007
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