Provider Demographics
NPI:1437396520
Name:LONGE, KAREN E (MPT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:LONGE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10448 WHEATLEY SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:VA
Mailing Address - Zip Code:20115-2672
Mailing Address - Country:US
Mailing Address - Phone:540-364-4112
Mailing Address - Fax:
Practice Address - Street 1:10448 WHEATLEY SCHOOL RD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:VA
Practice Address - Zip Code:20115-2672
Practice Address - Country:US
Practice Address - Phone:540-364-4112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist