Individual
ELETHIA V WAMPLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12825 MINNIEVILLE ROAD, SUITE 203, WOODBRIDGE, VA 22192-0045
(703) 971-3701
(301) 856-0964
Mailing address
9455 LORTON MARKET ST, LORTON, VA 22079-1963
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305002121
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46950017
CAREFIRST NCA
—
01
—
64468701
CAREFIRST MARYLAND
—
Enumeration date
07/18/2006
Last updated
09/10/2012
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