Provider Demographics
NPI:1215023072
Name:VASIL, MARC ANTHONY (PT)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:ANTHONY
Last Name:VASIL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 361098
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-0019
Mailing Address - Country:US
Mailing Address - Phone:440-229-5822
Mailing Address - Fax:440-448-4902
Practice Address - Street 1:5813 MAYFIELD RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2932
Practice Address - Country:US
Practice Address - Phone:440-229-5822
Practice Address - Fax:440-448-4902
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT092702251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2303715Medicaid
OH2303715Medicaid