Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 5899 | AZ |
NPI | 1013134717 |
---|---|
Provider Name | Melissa Charlotte Marviglia |
First Address | Queen Creek, AZ 85240-5207 |
Second Address | Gilbert, AZ 85297-8501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 13/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
722729 | (05) | AZ |