Provider Demographics
NPI:1700132982
Name:REYNOLDS, MARIELLE (DPT)
Entity Type:Individual
Prefix:
First Name:MARIELLE
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARIELLE
Other - Middle Name:
Other - Last Name:BONAROTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4115 WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1887
Mailing Address - Country:US
Mailing Address - Phone:724-327-7099
Mailing Address - Fax:724-327-0173
Practice Address - Street 1:4115 WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1887
Practice Address - Country:US
Practice Address - Phone:724-327-7099
Practice Address - Fax:724-327-0173
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist