Provider Demographics
NPI:1588797377
Name:MARENICK, TAMARA MARSHALL (PT)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:MARSHALL
Last Name:MARENICK
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 1:2951 LOG BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8232
Mailing Address - Country:US
Mailing Address - Phone:336-841-1254
Mailing Address - Fax:
Practice Address - Street 1:1795 WESTCHESTER DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7008
Practice Address - Country:US
Practice Address - Phone:336-888-4608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist