Provider Demographics
NPI:1639514516
Name:MARCELIN, PATRICIA G (PTA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:G
Last Name:MARCELIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11824 SW 107TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-3966
Mailing Address - Country:US
Mailing Address - Phone:212-203-8909
Mailing Address - Fax:
Practice Address - Street 1:11824 SW 107TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-3966
Practice Address - Country:US
Practice Address - Phone:212-203-8909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23958225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant