Provider Demographics
NPI:1063476075
Name:CARRACINO, MARIAN (PT)
Entity Type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:
Last Name:CARRACINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 WESTFALL RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2611
Mailing Address - Country:US
Mailing Address - Phone:585-271-3380
Mailing Address - Fax:585-271-2728
Practice Address - Street 1:880 WESTFALL RD
Practice Address - Street 2:SUITE D
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2611
Practice Address - Country:US
Practice Address - Phone:585-271-3380
Practice Address - Fax:585-271-2728
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC9776Medicare PIN