Provider Demographics
NPI:1477695070
Name:THERBER, MARCY LEE (PTA)
Entity Type:Individual
Prefix:MS
First Name:MARCY
Middle Name:LEE
Last Name:THERBER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 GRISSOM PKWY
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-9128
Mailing Address - Country:US
Mailing Address - Phone:321-433-5985
Mailing Address - Fax:
Practice Address - Street 1:2316 FISKE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3427
Practice Address - Country:US
Practice Address - Phone:321-632-0081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA18984174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist