Provider Demographics
NPI:1083708838
Name:LEPAGE, MARILYN (MSPT, COMT, CHT)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:LEPAGE
Suffix:
Gender:F
Credentials:MSPT, COMT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11240 WAPLES MILL RD
Mailing Address - Street 2:STE 403
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6078
Mailing Address - Country:US
Mailing Address - Phone:703-383-6454
Mailing Address - Fax:703-810-5494
Practice Address - Street 1:13350 FRANKLIN FARM RD STE 300
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4095
Practice Address - Country:US
Practice Address - Phone:703-810-5205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006773225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist