Provider Demographics
NPI:1063818854
Name:MARCHESSAULT, ERICA L (DPT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:L
Last Name:MARCHESSAULT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 ELDEN ST
Mailing Address - Street 2:SUITE 242
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4861
Mailing Address - Country:US
Mailing Address - Phone:703-689-3737
Mailing Address - Fax:703-689-3889
Practice Address - Street 1:150 ELDEN ST
Practice Address - Street 2:SUITE 242
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4861
Practice Address - Country:US
Practice Address - Phone:703-689-3737
Practice Address - Fax:703-689-3889
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist