Provider Demographics
NPI:1528153707
Name:WEATHERHEAD, DONALD CHARLES (DPT)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:CHARLES
Last Name:WEATHERHEAD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1769
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20118-1769
Mailing Address - Country:US
Mailing Address - Phone:540-687-8181
Mailing Address - Fax:540-687-8256
Practice Address - Street 1:209 MADISON ST
Practice Address - Street 2:SUITE LL2
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1764
Practice Address - Country:US
Practice Address - Phone:703-299-6688
Practice Address - Fax:703-299-3588
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204773225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist