Provider Demographics
NPI:1780769190
Name:MARCHESE, JON PAUL (PT)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:PAUL
Last Name:MARCHESE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:39 CALLE LOYOLA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-7018
Mailing Address - Country:US
Mailing Address - Phone:949-280-4783
Mailing Address - Fax:949-429-2319
Practice Address - Street 1:39 CALLE LOYOLA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-7018
Practice Address - Country:US
Practice Address - Phone:949-280-4783
Practice Address - Fax:949-429-2319
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 17911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist