Healthcare Provider Details

I. General information

NPI: 1548488083
Provider Name (Legal Business Name): MARJORIE ELLEN KALFON MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12801 OWLSLEY WAY
OAK HILL VA
20171-4225
US

IV. Provider business mailing address

12801 OWLSLEY WAY
OAK HILL VA
20171-4225
US

V. Phone/Fax

Practice location:
  • Phone: 703-395-6397
  • Fax:
Mailing address:
  • Phone: 703-390-1252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305202131
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: