Provider Demographics
NPI:1245332014
Name:MAROTTA, MICHAEL JAY (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAY
Last Name:MAROTTA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5337 TRUXTUN AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0641
Mailing Address - Country:US
Mailing Address - Phone:661-328-0650
Mailing Address - Fax:661-328-0654
Practice Address - Street 1:5337 TRUXTUN AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0641
Practice Address - Country:US
Practice Address - Phone:661-324-0122
Practice Address - Fax:661-324-0830
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOPT89262Medicare ID - Type UnspecifiedMEDICARE PPIN
CAS93515Medicare UPIN