Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 012690 | NY |
N | 2251N0400X | Physical Therapist - Neurology | 012690 | NY |
N | 2251P0200X | Physical Therapist - Pediatrics | 012690 | NY |
NPI | 1255610226 |
---|---|
Provider Name | Marybeth Marshall |
First Address | Cazenovia, NY 13035-9702 |
Second Address | Syracuse, NY 13210-2395 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2011 |
Last Update Date | 09/08/2011 |