Healthcare Provider Details

I. General information

NPI: 1063338374
Provider Name (Legal Business Name): MARCO VIRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 MAIN ST FL 1
PRINCE FREDERICK MD
20678-3189
US

IV. Provider business mailing address

2417 SHAFER ST
WALDORF MD
20601-4965
US

V. Phone/Fax

Practice location:
  • Phone: 410-414-3560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number30927
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: