Provider Demographics
NPI:1881916005
Name:SENDOWSKY, MARISSA NICOLE (DPT, PT, ATC)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:NICOLE
Last Name:SENDOWSKY
Suffix:
Gender:F
Credentials:DPT, PT, ATC
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:NICOLE
Other - Last Name:TICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4900 E CHAPMAN AVE
Mailing Address - Street 2:UNIT 13
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-4116
Mailing Address - Country:US
Mailing Address - Phone:714-624-2069
Mailing Address - Fax:
Practice Address - Street 1:710 E GOLDEN AVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-1635
Practice Address - Country:US
Practice Address - Phone:714-993-2093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT363522251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics