Provider Demographics
NPI:1295745644
Name:MARC FEDERICO PT LLC
Entity type:Organization
Organization Name:MARC FEDERICO PT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:FEDERICO
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:724-925-6260
Mailing Address - Street 1:621 SOUTH FIFTH STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:YOUNGWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:15697
Mailing Address - Country:US
Mailing Address - Phone:724-925-6260
Mailing Address - Fax:724-925-6260
Practice Address - Street 1:621 SOUTH FIFTH STREET
Practice Address - Street 2:SUITE B
Practice Address - City:YOUNGWOOD
Practice Address - State:PA
Practice Address - Zip Code:15697
Practice Address - Country:US
Practice Address - Phone:724-925-6260
Practice Address - Fax:724-925-6260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008417L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1784124OtherHIGHMARK
PA431807OtherHEALTH AMERICA
PA1235671OtherAETNA US HEALTHCARE
PA1235671OtherAETNA US HEALTHCARE
Q67614Medicare UPIN