Provider Demographics
NPI:1093829491
Name:WETMORE, ALISSA JEAN (DPT)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:JEAN
Last Name:WETMORE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 LUNA PARK DR
Mailing Address - Street 2:APT. #333
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-3168
Mailing Address - Country:US
Mailing Address - Phone:302-354-0102
Mailing Address - Fax:
Practice Address - Street 1:3299 WOODBURN RD
Practice Address - Street 2:SUITE 180
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1275
Practice Address - Country:US
Practice Address - Phone:703-849-8142
Practice Address - Fax:703-849-0735
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305204577225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist