Provider Demographics
NPI:1881914521
Name:LUNDIN, MARCIA MAE (DPT)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:MAE
Last Name:LUNDIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:MAE
Other - Last Name:KAFCHINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 866308
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75086-6308
Mailing Address - Country:US
Mailing Address - Phone:800-796-5464
Mailing Address - Fax:267-321-2099
Practice Address - Street 1:5400 SHAWNEE RD
Practice Address - Street 2:STE 104
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2300
Practice Address - Country:US
Practice Address - Phone:703-256-4830
Practice Address - Fax:703-256-4826
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0126001509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist