Provider Demographics
NPI:1417225103
Name:VANDEN NOVEN, MARNIE LYNN (MS PT)
Entity Type:Individual
Prefix:
First Name:MARNIE
Middle Name:LYNN
Last Name:VANDEN NOVEN
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:MARNIE
Other - Middle Name:LYNN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 NEW KING ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-1205
Mailing Address - Country:US
Mailing Address - Phone:914-390-9880
Mailing Address - Fax:914-390-9881
Practice Address - Street 1:4206 STAMMER PL
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-3302
Practice Address - Country:US
Practice Address - Phone:615-298-4555
Practice Address - Fax:615-298-4555
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist