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General NPI Number Information
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NPI Number | 1093829491
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Entity Type | Individual
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Provider Name | ALISSA JEAN WETMORE DPT
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Gender | Female
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3299 WOODBURN RD SUITE 180
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City | ANNANDALE
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State | VA
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Zip | 22003-1275
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Country | US
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Telephone | 703-849-8142
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Fax | 703-849-0735
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Provider Business Mailing Address
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Address Line | 100 LUNA PARK DR APT. #333
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City | ALEXANDRIA
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State | VA
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Zip | 22305-3168
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Country | US
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Telephone | 302-354-0102
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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 | 2305204577
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License Number State | VA
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