Provider Demographics
NPI:1578702676
Name:COHEN, MARLA (PT)
Entity Type:Individual
Prefix:MS
First Name:MARLA
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 HOAG LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-2508
Mailing Address - Country:US
Mailing Address - Phone:315-637-7209
Mailing Address - Fax:315-637-7209
Practice Address - Street 1:5201 HOAG LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-2508
Practice Address - Country:US
Practice Address - Phone:315-637-7209
Practice Address - Fax:315-637-7209
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014990-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics