Provider Demographics
NPI:1326291147
Name:USATINA, MARIYA (PT MS)
Entity Type:Individual
Prefix:
First Name:MARIYA
Middle Name:
Last Name:USATINA
Suffix:
Gender:F
Credentials:PT MS
Other - Prefix:
Other - First Name:MASHA
Other - Middle Name:
Other - Last Name:USATIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT MS
Mailing Address - Street 1:33 POND AVE APT 1204
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33 POND AVE APT 1204
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7159
Practice Address - Country:US
Practice Address - Phone:617-903-8283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017456225100000X
MA190072251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist