Basic Information
| Provider Information | |||||||||
| NPI: | 1659514206 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARCHESE | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | PT ASSISTANT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 86 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554860086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108599110 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1999 SPROUL RD | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | BROOMALL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190083508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103591134 | ||||||||
| FaxNumber: | 6103532109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2009 | ||||||||
| LastUpdateDate: | 04/13/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | TEI002213 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.