Provider Demographics
NPI:1548488083
Name:KALFON, MARJORIE ELLEN (MPT)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ELLEN
Last Name:KALFON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12801 OWLSLEY WAY
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20171-4225
Mailing Address - Country:US
Mailing Address - Phone:703-390-1252
Mailing Address - Fax:
Practice Address - Street 1:12801 OWLSLEY WAY
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:VA
Practice Address - Zip Code:20171-4225
Practice Address - Country:US
Practice Address - Phone:703-395-6397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
J757-OOO4OtherBCBS
J757-OOO4OtherBCBS