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General NPI Number Information
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NPI Number | 1073328241
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Entity Type | Individual
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Provider Name | SHANE MONDLOCH
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Gender | Male
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 08/09/2025
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Provider Practice Location Address
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Address Line | 1715 N GEORGE MASON DR STE 504
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City | ARLINGTON
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State | VA
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Zip | 22205-3670
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Country | US
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Telephone | 703-525-2220
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Fax |
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Provider Business Mailing Address
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Address Line | 6671 COLTON CRAWFORD CIR
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City | FALLS CHURCH
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State | VA
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Zip | 22042-2267
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305217306
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License Number State | VA
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