MEDICARE: ROSSNIEL MARINAS DPT - BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT 21736	FL
2	103K00000X	Behavior Analyst	BCBA1-23-65381	FL

General Provider Information

NPI Number	:	1578682563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSSNIEL MARINAS DPT - BCBA

Provider Business Mailing Address
First Line	:	6460 W 27TH CT APT 22
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-4317
Country	:	US
Telephone Number	:	305-979-1776
Fax Number	:

Provider Business Practice Location Address
First Line	:	6460 W 27TH CT APT 22
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-4317
Country	:	US
Telephone Number	:	305-979-1776
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/13/2023

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