Provider Demographics
NPI:1689863524
Name:MAGNO, MARVIN JOSEPH M (PT)
Entity Type:Individual
Prefix:
First Name:MARVIN JOSEPH
Middle Name:M
Last Name:MAGNO
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 1:707 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-3917
Mailing Address - Country:US
Mailing Address - Phone:336-885-0141
Mailing Address - Fax:336-885-1404
Practice Address - Street 1:707 N ELM ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3917
Practice Address - Country:US
Practice Address - Phone:336-885-0141
Practice Address - Fax:336-885-1404
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP11469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL567700OtherMEDICARE GROUP NUMBER
IL568150OtherMEDICARE GROUP NUMBER
IL1619908OtherBCBS IL GROUP
IL568080OtherMEDICARE GROUP NUMBER
ILK49658Medicare PIN
IL567700OtherMEDICARE GROUP NUMBER
ILK49659Medicare PIN