Provider Demographics
NPI: | 1437173622 |
---|---|
Name: | MARSIGLI, DOUGLAS TODD (DPT) |
Entity Type: | Individual |
Prefix: | MR |
First Name: | DOUGLAS |
Middle Name: | TODD |
Last Name: | MARSIGLI |
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: | 3517 SHEFFIELD DR |
Mailing Address - Street 2: | |
Mailing Address - City: | ROCKY MOUNT |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27803-1232 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 252-443-5247 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2413 PROFESSIONAL DR |
Practice Address - Street 2: | |
Practice Address - City: | ROCKY MOUNT |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27804-2254 |
Practice Address - Country: | US |
Practice Address - Phone: | 252-443-0808 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-27 |
Last Update Date: | 2009-01-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 8133 | 2251E1300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2251E1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Electrophysiology, Clinical |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 126WC | Other | BCBS |
NC | 282764 | Other | MAMSI |
NC | 98866 | Other | MEDCOST |
NC | 7210779 | Medicaid | |
NC | 2504526A | Medicare ID - Type Unspecified |