Provider Demographics
NPI:1396788790
Name:CRAIG, MARGAUX W (MSPT)
Entity type:Individual
Prefix:
First Name:MARGAUX
Middle Name:W
Last Name:CRAIG
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:MARGAUX
Other - Middle Name:A
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:5901 KINGSTOWNE VILLAGE PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5880
Mailing Address - Country:US
Mailing Address - Phone:703-924-2650
Mailing Address - Fax:703-924-2653
Practice Address - Street 1:5901 KINGSTOWNE VILLAGE PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5880
Practice Address - Country:US
Practice Address - Phone:703-924-2650
Practice Address - Fax:703-924-2653
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT870379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC020647S57Medicare PIN