Organization
PROACTIVE PHYSICAL THERAPY AND WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHAVONE JOHNSON (PHYSICAL THERAPIST)
(571) 294-3557
Entity
Organization
Contact information
Practice address
3903 FAIR RIDGE DR, 211, FAIRFAX, VA 22033-2943
(571) 294-3557
Mailing address
3903 FAIR RIDGE DR, 211, FAIRFAX, VA 22033-2943
(571) 294-3557
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
2305204873
VA
Other
Enumeration date
03/09/2015
Last updated
08/03/2015
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