Healthcare Provider Details

I. General information

NPI: 1396788790
Provider Name (Legal Business Name): MARGAUX W CRAIG MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARGAUX A WALLACE MSPT

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 KINGSTOWNE VILLAGE PKWY SUITE 301
ALEXANDRIA VA
22315-5880
US

IV. Provider business mailing address

5901 KINGSTOWNE VILLAGE PKWY SUITE 301
ALEXANDRIA VA
22315-5880
US

V. Phone/Fax

Practice location:
  • Phone: 703-924-2650
  • Fax: 703-924-2653
Mailing address:
  • Phone: 703-924-2650
  • Fax: 703-924-2653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT870379
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: