Provider Demographics
NPI:1710105721
Name:MARION, EDWARD R (DPT, MA)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:R
Last Name:MARION
Suffix:
Gender:M
Credentials:DPT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-2522
Mailing Address - Country:US
Mailing Address - Phone:732-610-2528
Mailing Address - Fax:
Practice Address - Street 1:25 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859-2522
Practice Address - Country:US
Practice Address - Phone:732-610-2528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA07103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist