Provider Demographics
NPI:1619321338
Name:MARCINIAK, JOAN (PT)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:MARCINIAK
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 1:1020 KINGS HWY N
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1906
Mailing Address - Country:US
Mailing Address - Phone:856-330-4360
Mailing Address - Fax:856-330-4281
Practice Address - Street 1:1020 KINGS HWY N
Practice Address - Street 2:SUITE 108
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1906
Practice Address - Country:US
Practice Address - Phone:856-330-4360
Practice Address - Fax:856-330-4281
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00447200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist