Provider Demographics
NPI:1548570658
Name:PEPPERS, MILEY CRAIG III (DPT)
Entity type:Individual
Prefix:
First Name:MILEY
Middle Name:CRAIG
Last Name:PEPPERS
Suffix:III
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2657 CENTENNIAL CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1303
Mailing Address - Country:US
Mailing Address - Phone:240-286-3822
Mailing Address - Fax:
Practice Address - Street 1:2657 CENTENNIAL CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1303
Practice Address - Country:US
Practice Address - Phone:240-286-3822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052072662251X0800X
DCPT8715462251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic