Healthcare Provider Details

I. General information

NPI: 1811402597
Provider Name (Legal Business Name): STACY PEPITONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8348 TRAFORD LN STE 100
SPRINGFIELD VA
22152-1650
US

IV. Provider business mailing address

8348 TRAFORD LN STE 100
SPRINGFIELD VA
22152-1650
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-7335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305212386
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: