Provider Demographics
NPI:1376564526
Name:MARSTON, COBURN ARTHUR (PT)
Entity Type:Individual
Prefix:MR
First Name:COBURN
Middle Name:ARTHUR
Last Name:MARSTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S 11TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5767
Mailing Address - Country:US
Mailing Address - Phone:352-787-3609
Mailing Address - Fax:352-314-8979
Practice Address - Street 1:101 S 11TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5767
Practice Address - Country:US
Practice Address - Phone:352-787-3609
Practice Address - Fax:352-314-8979
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 1647225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0659Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER