Provider Demographics
NPI:1063666881
Name:MARCELLINO, THOMAS L (PT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:MARCELLINO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 TOC DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-1506
Mailing Address - Country:US
Mailing Address - Phone:845-691-9791
Mailing Address - Fax:
Practice Address - Street 1:40 TOC DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-1506
Practice Address - Country:US
Practice Address - Phone:845-389-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012352-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist