Provider Demographics
NPI:1235614231
Name:OWENS, MARCUS (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:OWENS
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 DOUBLE EAGLE CT
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-2401
Mailing Address - Country:US
Mailing Address - Phone:571-224-6048
Mailing Address - Fax:
Practice Address - Street 1:520 EVERGREEN MILL RD SE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-8726
Practice Address - Country:US
Practice Address - Phone:571-252-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260018242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer