Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 2305212074 | VA |
NPI | 1033751300 |
---|---|
Provider Name | Kathryn R. Wason |
First Address | Charlottesville, VA 22901-8126 |
Second Address | Charlottesville, VA 22901-8126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2019 |
Last Update Date | 14/09/2020 |