Provider Demographics
NPI:1326697707
Name:LONG, MARIE CAMILLE (DPT)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:CAMILLE
Last Name:LONG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15530 W 64TH AVE UNIT E
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-6874
Mailing Address - Country:US
Mailing Address - Phone:303-424-4589
Mailing Address - Fax:303-424-4632
Practice Address - Street 1:15530 W 64TH AVE UNIT E
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007-6874
Practice Address - Country:US
Practice Address - Phone:303-424-4589
Practice Address - Fax:303-424-4632
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24377225100000X
OR64688225100000X
CO20712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist