Individual
MADISON SOUPISET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT, PT
Contact information
Practice address
12825 MINNIEVILLE RD STE 203, LAKE RIDGE, VA 22192-3602
(703) 647-3130
Mailing address
5706 FLAGLER DR, CENTREVILLE, VA 20120-2959
(319) 600-2200
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305216272
VA
225100000X
Physical Therapist
—
—
Other
Enumeration date
11/17/2023
Last updated
02/05/2024
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