Healthcare Provider Details

I. General information

NPI: 1033751300
Provider Name (Legal Business Name): KATHRYN R. WASON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 HYDRAULIC RIDGE ROAD SUITE 4
CHARLOTTESVILLE VA
22901-8126
US

IV. Provider business mailing address

285 HYDRAULIC RIDGE ROAD SUITE 4
CHARLOTTESVILLE VA
22901-8126
US

V. Phone/Fax

Practice location:
  • Phone: 434-817-0980
  • Fax: 434-817-0985
Mailing address:
  • Phone: 434-817-0980
  • Fax: 434-817-0985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number2305212074
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: