Provider Demographics
NPI:1487184032
Name:LASSITER, MARGO (PT)
Entity Type:Individual
Prefix:
First Name:MARGO
Middle Name:
Last Name:LASSITER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13974 BLAZER LN
Mailing Address - Street 2:
Mailing Address - City:LOVETTSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20180-3142
Mailing Address - Country:US
Mailing Address - Phone:703-727-4063
Mailing Address - Fax:
Practice Address - Street 1:205 HIRST RD STE 201E
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6600
Practice Address - Country:US
Practice Address - Phone:540-338-3230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11969225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist