Provider Demographics
NPI:1750610119
Name:PEZNOLA, MARIANNE (PT)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:PEZNOLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARRIANE
Other - Middle Name:
Other - Last Name:TARSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:235 CYPRESS ST
Mailing Address - Street 2:STE 110
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6777
Mailing Address - Country:US
Mailing Address - Phone:617-860-6430
Mailing Address - Fax:617-860-3164
Practice Address - Street 1:39 CINEMA BLVD
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3290
Practice Address - Country:US
Practice Address - Phone:978-466-6677
Practice Address - Fax:978-466-1133
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist