Individual provider Active NPI

Marin H Bronaugh, DPT, PT

  • Physical Therapist
  • Herndon, VA
National Provider Identifier
1093669608
Registry record updated Feb 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305217580 Issued in VA
Practice address
13039 Worldgate Dr
Herndon, VA 20170-4374
Phone
(703) 689-3164
Fax
(703) 689-3167
NPI assigned
Feb 23, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2305217580 VA Primary

Addresses

Primary practice location

13039 Worldgate Dr
Herndon, VA 20170-4374

Mailing address

12701 Fair Lakes Cir Ste 102
Fairfax, VA 22033-4913
Phone (703) 689-3164

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20260313004214 DC Practitioner - Physical Therapist in Private Practice 4082197348 Reassigns benefits to 1 organization
I20260424000939 VA Practitioner - Physical Therapist in Private Practice 4082197348 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1300 W Sam Houston Pkwy S
Suite 300
Houston, TX 77042-2453

13039 Worldgate Dr
Herndon, VA 20170-4374

43490 Yukon Dr
Suite 212
Ashburn, VA 20147-6990

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2305217580VAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson Clinics Limited Partnership Physical Therapist CurrentSince Mar 6, 2026 Accepting new patients

Locations

43490 Yukon Dr
Ashburn, VA 20147
Phone (703) 729-7920

12701 Fair Lakes Cir
Ste 102
Fairfax, VA 22033

13039 Worldgate Dr
Herndon, VA 20170
Phone (703) 689-3164

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1771804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771804800000",
    "number": "1093669608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12701 FAIR LAKES CIR STE 102",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220334913",
            "telephone_number": "703-689-3164",
            "fax_number": "703-689-3167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13039 WORLDGATE DR",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201704374",
            "telephone_number": "703-689-3164",
            "fax_number": "703-689-3167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRONAUGH",
        "first_name": "MARIN",
        "middle_name": "H",
        "credential": "DPT, PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-02-23",
        "last_updated": "2026-02-23",
        "certification_date": "2026-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305217580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Herndon, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.