Provider Demographics
NPI:1063023513
Name:MARSH, BIRTTANY D (LMT)
Entity Type:Individual
Prefix:MS
First Name:BIRTTANY
Middle Name:D
Last Name:MARSH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 W SENECA TPKE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-2225
Mailing Address - Country:US
Mailing Address - Phone:315-857-5557
Mailing Address - Fax:315-320-9235
Practice Address - Street 1:4922 W SENECA TPKE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-2225
Practice Address - Country:US
Practice Address - Phone:315-857-5557
Practice Address - Fax:315-320-9235
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0581702225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist