Provider Demographics
NPI:1326114273
Name:MAROLLA, MICHAEL PAUL (DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PAUL
Last Name:MAROLLA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LODGE POLE LANE
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07419
Mailing Address - Country:US
Mailing Address - Phone:973-835-2827
Mailing Address - Fax:973-835-1856
Practice Address - Street 1:2025 HAMBURG TPKE
Practice Address - Street 2:SUITE E
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6260
Practice Address - Country:US
Practice Address - Phone:973-835-2827
Practice Address - Fax:973-835-1856
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01186500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist