Provider Demographics
NPI:1518511062
Name:ITALIA, MARCO ANTONIO (PT,DPT)
Entity type:Individual
Prefix:DR
First Name:MARCO
Middle Name:ANTONIO
Last Name:ITALIA
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 BLUFFTON PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4602
Mailing Address - Country:US
Mailing Address - Phone:843-837-5236
Mailing Address - Fax:843-837-1004
Practice Address - Street 1:4810 BLUFFTON PKWY STE 102
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4602
Practice Address - Country:US
Practice Address - Phone:843-837-5236
Practice Address - Fax:843-837-1004
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34939225100000X
SC13082225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist