MEDICARE: CHRISTINA MARCUS

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	225200000X	Physical Therapy Assistant	1418	SC

General Provider Information

NPI Number	:	1962805143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA MARCUS

Provider Business Mailing Address
First Line	:	2060 NORTHBROOK BLVD STE 101
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9811
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2060 NORTHBROOK BLVD STE 101
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9811
Country	:	US
Telephone Number	:	843-797-5167
Fax Number	:

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

Provider Enumeration Date	:	10/02/2014
Last Update Date	:	10/02/2014

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Directions to “ CHRISTINA MARCUS ” Practice Location

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