Provider Demographics
NPI:1639673353
Name:MARCONYAK, MARIAN (PHD, PT)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:MARCONYAK
Suffix:
Gender:F
Credentials:PHD, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 JOSEPHINE CRES
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-3918
Mailing Address - Country:US
Mailing Address - Phone:757-635-5006
Mailing Address - Fax:
Practice Address - Street 1:7000 W TANNERS CREEK DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-1151
Practice Address - Country:US
Practice Address - Phone:757-635-5006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist