Provider Demographics
NPI:1669852877
Name:SAMSEL-WITKUS, MARCIA A (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:A
Last Name:SAMSEL-WITKUS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:MRS
Other - First Name:MARCIA
Other - Middle Name:A
Other - Last Name:SAMSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPTA
Mailing Address - Street 1:715 MENDON RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01534-1340
Mailing Address - Country:US
Mailing Address - Phone:508-266-0587
Mailing Address - Fax:
Practice Address - Street 1:670 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:WHITINSVILLE
Practice Address - State:MA
Practice Address - Zip Code:01588-2068
Practice Address - Country:US
Practice Address - Phone:508-234-7544
Practice Address - Fax:508-234-8002
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3420225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant