Provider Demographics
NPI:1528390242
Name:BIRREY, MARLON CHUAH (PT)
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:CHUAH
Last Name:BIRREY
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 1:12292 LONGVIEW LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-4965
Mailing Address - Country:US
Mailing Address - Phone:585-319-8335
Mailing Address - Fax:
Practice Address - Street 1:2888 RINGLING BLVD UNIT C&D
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-5331
Practice Address - Country:US
Practice Address - Phone:585-319-8335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25327225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty