MEDICARE: KATIE MARSALA PT

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	2251P0200X	Pediatric Physical Therapist	40QA01201200	NJ

General Provider Information

NPI Number	:	1639460538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE MARSALA PT

Provider Business Mailing Address
First Line	:	1641 ELM AVE APT 20
Second Line	:
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-4517
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1641 ELM AVE APT 20
Second Line	:
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-4517
Country	:	US
Telephone Number	:	732-903-6776
Fax Number	:

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

Provider Enumeration Date	:	04/26/2011
Last Update Date	:	04/26/2011

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Directions to “ KATIE MARSALA PT” Practice Location

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