Provider Demographics
NPI:1205960275
Name:MARINO-SMITH, DAWN (PTA)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:
Last Name:MARINO-SMITH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 GEORGIA RD
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8042
Mailing Address - Country:US
Mailing Address - Phone:732-761-9801
Mailing Address - Fax:
Practice Address - Street 1:221 GEORGIA RD
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8042
Practice Address - Country:US
Practice Address - Phone:732-761-9801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00178100225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant