Provider Demographics
NPI:1780794495
Name:MARCINIAK, ANNE
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:MARCINIAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8424 WISWELL ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45216-1225
Mailing Address - Country:US
Mailing Address - Phone:513-821-3722
Mailing Address - Fax:
Practice Address - Street 1:6499 S MASON MONTGOMERY RD
Practice Address - Street 2:STE D
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1764
Practice Address - Country:US
Practice Address - Phone:513-336-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH06746OtherLICENSE #