Provider Demographics
NPI:1790956316
Name:MAGNO, MARISON MILLORA (PT)
Entity Type:Individual
Prefix:MS
First Name:MARISON
Middle Name:MILLORA
Last Name:MAGNO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 N BROADWAY
Mailing Address - Street 2:APARTMENT 210
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-1540
Mailing Address - Country:US
Mailing Address - Phone:443-850-0475
Mailing Address - Fax:410-675-4161
Practice Address - Street 1:4700 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-3204
Practice Address - Country:US
Practice Address - Phone:410-254-3300
Practice Address - Fax:410-254-3099
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-23
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD21415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist