Basic Information
| Provider Information | |||||||||
| NPI: | 1083708838 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEPAGE | ||||||||
| FirstName: | MARILYN | ||||||||
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| Credential: | MSPT, COMT, CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11240 WAPLES MILL RD | ||||||||
| Address2: | STE 403 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220306078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033836454 | ||||||||
| FaxNumber: | 7038105494 | ||||||||
| Practice Location | |||||||||
| Address1: | 13350 FRANKLIN FARM RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | HERNDON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201714095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038105205 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305006773 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.