Provider Demographics
NPI:1760775332
Name:MARINO, AMANDA CATHERINE (DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CATHERINE
Last Name:MARINO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10705 CHARTER DR
Mailing Address - Street 2:SUITE 420
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2893
Mailing Address - Country:US
Mailing Address - Phone:443-283-2018
Mailing Address - Fax:443-283-0628
Practice Address - Street 1:10705 CHARTER DR
Practice Address - Street 2:420
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2893
Practice Address - Country:US
Practice Address - Phone:443-283-2018
Practice Address - Fax:443-283-0628
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist