Healthcare Provider Details

I. General information

NPI: 1932391562
Provider Name (Legal Business Name): MELINDA R WOWAK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELINDA BEDDO DPT

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10716 RICHMOND HWY STE 103
LORTON VA
22079-2645
US

IV. Provider business mailing address

2800 S SHIRLINGTON RD STE 1100
ARLINGTON VA
22206-3605
US

V. Phone/Fax

Practice location:
  • Phone: 703-892-6500
  • Fax: 703-521-3415
Mailing address:
  • Phone: 703-892-6500
  • Fax: 703-521-3415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305206738
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: