Provider Demographics
NPI:1891797478
Name:MARSTON, THOMAS J (MSPT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:MARSTON
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:502-576-3282
Mailing Address - Fax:
Practice Address - Street 1:652 WOOD ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-2425
Practice Address - Country:US
Practice Address - Phone:401-785-1016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014677225100000X
RI03603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY364247OtherMVP
NY040617000038OtherFIDELIS
NY10025376OtherCDPHP
NY000406994010OtherBSNENY
NY3439517OtherAETNA
NY01966921Medicaid
NY813120OtherMPN
NYQ03G11OtherEMPIRE BC
NY227921OtherWELLCARE
NY6697905OtherGHI
NY000406994010OtherBSNENY
NYRA0807Medicare PIN