Provider Demographics
NPI: | 1861499345 |
---|---|
Name: | MARZIANO, ANTHONY JR (MPT) |
Entity Type: | Individual |
Prefix: | MR |
First Name: | ANTHONY |
Middle Name: | |
Last Name: | MARZIANO |
Suffix: | JR |
Gender: | M |
Credentials: | MPT |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 237 TALBOT DR |
Mailing Address - Street 2: | |
Mailing Address - City: | BROOMALL |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19008-3728 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 610-356-4666 |
Mailing Address - Fax: | 610-896-4385 |
Practice Address - Street 1: | 1410 MANOA RD |
Practice Address - Street 2: | |
Practice Address - City: | WYNNEWOOD |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19096-3208 |
Practice Address - Country: | US |
Practice Address - Phone: | 610-896-9000 |
Practice Address - Fax: | 610-896-4385 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-06-30 |
Last Update Date: | 2010-06-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | PT006241L | 225100000X, 2251C2600X, 2251E1200X, 2251E1300X, 2251G0304X, 2251H1200X, 2251N0400X, 2251P0200X, 2251S0007X, 2251X0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | |
No | 2251C2600X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Cardiopulmonary |
No | 2251E1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Ergonomics |
No | 2251E1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Electrophysiology, Clinical |
No | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics |
No | 2251H1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand |
No | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology |
No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports |
No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 464895 | Medicare ID - Type Unspecified |