Provider Demographics
NPI:1932329703
Name:MARIETTA THERAPY ASSOCIATES
Entity Type:Organization
Organization Name:MARIETTA THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:SPEAR
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MS,ATC
Authorized Official - Phone:740-374-3200
Mailing Address - Street 1:160 GROSS ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2031
Mailing Address - Country:US
Mailing Address - Phone:740-374-3200
Mailing Address - Fax:
Practice Address - Street 1:160 GROSS ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2031
Practice Address - Country:US
Practice Address - Phone:740-374-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0169700001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0169700001Medicare ID - Type UnspecifiedADMINISTAR FEDERAL