Provider Demographics
NPI:1841564549
Name:SCHUBERT, MARISSA (DPT)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:SCHUBERT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:CARRATELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 NEWPORT CENTER DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7501
Mailing Address - Country:US
Mailing Address - Phone:562-777-1333
Mailing Address - Fax:562-777-1347
Practice Address - Street 1:2101 E 4TH ST STE 170
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3814
Practice Address - Country:US
Practice Address - Phone:714-558-3977
Practice Address - Fax:714-558-0308
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 38809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGF896ZMedicare PIN