Provider Demographics
NPI:1811901101
Name:EAST, MARILYN (DPT)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:EAST
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FROST LN
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3638
Mailing Address - Country:US
Mailing Address - Phone:508-771-0604
Mailing Address - Fax:
Practice Address - Street 1:681 FALMOUTH RD
Practice Address - Street 2:UNIT 24D
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3327
Practice Address - Country:US
Practice Address - Phone:508-477-5670
Practice Address - Fax:508-539-1790
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist