Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 012858-1 | NY |
NPI | 1114234390 |
---|---|
Provider Name | Marina I Marsh |
First Address | Massapequa Park, NY 11762-1301 |
Second Address | Massapequa Park, NY 11762-1301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2010 |
Last Update Date | 08/09/2010 |