Provider Demographics
NPI:1124383443
Name:MACKLES, MARION (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARION
Middle Name:
Last Name:MACKLES
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 1:22 W 38TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-6262
Mailing Address - Country:US
Mailing Address - Phone:212-921-0214
Mailing Address - Fax:212-921-0217
Practice Address - Street 1:22 W 38TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-6262
Practice Address - Country:US
Practice Address - Phone:212-921-0214
Practice Address - Fax:212-921-0217
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist