Provider Demographics
NPI:1609277425
Name:DEMARIO, REBECCA PAIGE (ATC)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:PAIGE
Last Name:DEMARIO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5721 HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:JORDAN
Mailing Address - State:NY
Mailing Address - Zip Code:13080-9760
Mailing Address - Country:US
Mailing Address - Phone:315-689-8510
Mailing Address - Fax:
Practice Address - Street 1:31 EMORY AVE
Practice Address - Street 2:
Practice Address - City:CAZENOVIA
Practice Address - State:NY
Practice Address - Zip Code:13035-1043
Practice Address - Country:US
Practice Address - Phone:315-436-4465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002533-12255A2300X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer