Provider Demographics
NPI:1225406986
Name:MARINHO, ANA (PT)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:MARINHO
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 1:11111 BRUSH HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-7113
Mailing Address - Country:US
Mailing Address - Phone:424-225-2313
Mailing Address - Fax:310-460-0099
Practice Address - Street 1:11111 BRUSH HOLLOW RD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-7113
Practice Address - Country:US
Practice Address - Phone:424-225-2313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT42719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB248011OtherMEDICARE PTAN