Provider Demographics
NPI:1962471359
Name:FORREST, MARC CHRISTOPHER (MSPT)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:CHRISTOPHER
Last Name:FORREST
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 THIMBLE SHOALS BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4562
Mailing Address - Country:US
Mailing Address - Phone:757-873-1557
Mailing Address - Fax:757-873-3239
Practice Address - Street 1:730 THIMBLE SHOALS BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4562
Practice Address - Country:US
Practice Address - Phone:757-873-1557
Practice Address - Fax:757-873-3239
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA54209OtherOPTIMA HEALTH
VA245488OtherBLUE CROSS BLUE SHIELD
VA1174592042Medicaid
VA541869550OtherVIRGINIA HEALTH NETWORK
VA245488OtherBLUE CROSS BLUE SHIELD