Provider Demographics
NPI:1679649578
Name:LINTAL, MARC E (PT)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:E
Last Name:LINTAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 STUDENT HEALTH CENTER
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:16802
Mailing Address - Country:US
Mailing Address - Phone:814-863-6747
Mailing Address - Fax:814-863-8464
Practice Address - Street 1:308 STUDENT HEALTH CENTER
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16802
Practice Address - Country:US
Practice Address - Phone:814-863-6747
Practice Address - Fax:814-863-8464
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015353225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP84165Medicare UPIN
PA068124KAOMedicare ID - Type UnspecifiedMEDICARE#
PA068124R9XMedicare Oscar/Certification