MEDICARE: ANTHONY R MARSALA PT, MPT, ATC

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	029203	NY
2	225100000X	Physical Therapist	40QA01264800	NJ

General Provider Information

NPI Number	:	1801929427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY R MARSALA PT, MPT, ATC

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	:	516-672-2923
Fax Number	:

Provider Business Practice Location Address
First Line	:	1641 ELM AVE APT 20
Second Line	:
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742
Country	:	US
Telephone Number	:	516-672-2923
Fax Number	:

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/06/2018

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