Provider Demographics
NPI:1942772256
Name:JEPSON, ALISA ANNE (PT, DPT)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:ANNE
Last Name:JEPSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8260 WILLOW OAKS CORPORATE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4513
Mailing Address - Country:US
Mailing Address - Phone:571-472-2160
Mailing Address - Fax:
Practice Address - Street 1:8260 WILLOW OAKS CORPORATE DR STE 300
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4513
Practice Address - Country:US
Practice Address - Phone:571-472-2160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA2305213183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program