Provider Demographics
NPI:1871618140
Name:MARSHALL, MARYANN BAIN (PT)
Entity type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:BAIN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-3133
Mailing Address - Country:US
Mailing Address - Phone:631-567-4317
Mailing Address - Fax:631-567-4317
Practice Address - Street 1:297 FOSTER AVE
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-3133
Practice Address - Country:US
Practice Address - Phone:631-567-4317
Practice Address - Fax:631-567-4317
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist