Provider Demographics
NPI:1114073517
Name:MARRIOTT, JOSEPH (MPT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MARRIOTT
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 S MAIN RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-1903
Mailing Address - Country:US
Mailing Address - Phone:570-208-5544
Mailing Address - Fax:
Practice Address - Street 1:119 S MAIN RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707-1903
Practice Address - Country:US
Practice Address - Phone:570-208-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008486L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA039084Medicare ID - Type Unspecified