Provider Demographics
NPI:1669460812
Name:MAURIN, MARIAN ELIZABETH (PT)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:ELIZABETH
Last Name:MAURIN
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 1:3820 NORTHDALE BLVD
Mailing Address - Street 2:STE 302B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1863
Mailing Address - Country:US
Mailing Address - Phone:813-418-7350
Mailing Address - Fax:813-265-2504
Practice Address - Street 1:1501 W CLEVELAND ST
Practice Address - Street 2:STE 220
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1812
Practice Address - Country:US
Practice Address - Phone:813-805-8105
Practice Address - Fax:813-254-3055
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21754225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y070ROtherBLUE CROSS BLUE SHIELD
U4043Medicare UPIN
U4043ZMedicare ID - Type Unspecified