Provider Demographics
NPI:1518399153
Name:LEYDIG, MARISSA JOY (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:JOY
Last Name:LEYDIG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MARISSA
Other - Middle Name:JOY
Other - Last Name:BUTERBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:723 SHORT CUT RD
Mailing Address - Street 2:
Mailing Address - City:ALUM BANK
Mailing Address - State:PA
Mailing Address - Zip Code:15521-8661
Mailing Address - Country:US
Mailing Address - Phone:814-977-3620
Mailing Address - Fax:
Practice Address - Street 1:9709 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-3717
Practice Address - Country:US
Practice Address - Phone:814-652-3220
Practice Address - Fax:814-652-3230
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396797Medicare Oscar/Certification