Provider Demographics
NPI:1205952546
Name:MAROVINO, TIZIANO ANDREW (DPT)
Entity type:Individual
Prefix:
First Name:TIZIANO
Middle Name:ANDREW
Last Name:MAROVINO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5417 WHITTAKER RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9751
Practice Address - Country:US
Practice Address - Phone:734-483-9200
Practice Address - Fax:734-483-9202
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010045802251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN69750068Medicare PIN
MIMI6211020Medicare PIN
MIOH11283OtherBXBS-PHYSICAL THERAPY