Provider Demographics
NPI:1114006384
Name:MEADOWS, MARC OWEN (PT)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:OWEN
Last Name:MEADOWS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:46304 MCCLELLAN WAY
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-7243
Mailing Address - Country:US
Mailing Address - Phone:703-444-8210
Mailing Address - Fax:703-444-8213
Practice Address - Street 1:46304 MCCLELLAN WAY
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-7243
Practice Address - Country:US
Practice Address - Phone:703-444-8210
Practice Address - Fax:703-444-8213
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003185225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist