Provider Demographics
NPI:1376817361
Name:MARRIOTT, ANDREW DAMION (DPT)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:DAMION
Last Name:MARRIOTT
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 1:8360 118TH ST APT 3F
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2312
Mailing Address - Country:US
Mailing Address - Phone:917-701-7401
Mailing Address - Fax:
Practice Address - Street 1:8360 118TH ST APT 3F
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-2312
Practice Address - Country:US
Practice Address - Phone:917-701-7401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62025652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist