Provider Demographics
NPI:1851839815
Name:MARCHETTI PHYSICAL MEDICINE P.A.
Entity Type:Organization
Organization Name:MARCHETTI PHYSICAL MEDICINE P.A.
Other - Org Name:MODOMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-402-4825
Mailing Address - Street 1:4944 PRESTON RD
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-8597
Mailing Address - Country:US
Mailing Address - Phone:469-304-3443
Mailing Address - Fax:469-304-3443
Practice Address - Street 1:4944 PRESTON RD STE 100A
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-8987
Practice Address - Country:US
Practice Address - Phone:469-304-3443
Practice Address - Fax:469-304-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
TXL7470208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty