Provider Demographics
NPI:1780863027
Name:SARRICA, MARCELLO (DPT)
Entity Type:Individual
Prefix:DR
First Name:MARCELLO
Middle Name:
Last Name:SARRICA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 BAY RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2702
Mailing Address - Country:US
Mailing Address - Phone:347-560-6920
Mailing Address - Fax:347-560-6748
Practice Address - Street 1:474 BAY RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2702
Practice Address - Country:US
Practice Address - Phone:347-560-6920
Practice Address - Fax:347-560-6748
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028696225100000X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY028696OtherNYS LICENSE