Provider Demographics
NPI:1851474613
Name:MARCIONI, ROBERT GERALD (P T)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GERALD
Last Name:MARCIONI
Suffix:
Gender:M
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 COLDSTREAM CT
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6402
Mailing Address - Country:US
Mailing Address - Phone:937-847-8063
Mailing Address - Fax:
Practice Address - Street 1:2200 COLDSTREAM CT
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-6402
Practice Address - Country:US
Practice Address - Phone:937-847-8063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist