Provider Demographics
NPI:1780636365
Name:JOYCE, MARILYN LENORE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:LENORE
Last Name:JOYCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 N PARK LN
Mailing Address - Street 2:
Mailing Address - City:PERALTA
Mailing Address - State:NM
Mailing Address - Zip Code:87042-8431
Mailing Address - Country:US
Mailing Address - Phone:505-869-0545
Mailing Address - Fax:
Practice Address - Street 1:3301 COORS BLVD NW
Practice Address - Street 2:K-2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1292
Practice Address - Country:US
Practice Address - Phone:505-866-1677
Practice Address - Fax:505-866-1767
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist