Healthcare Provider Details

I. General information

NPI: 1013134717
Provider Name (Legal Business Name): MELISSA CHARLOTTE MARVIGLIA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3341 E QUEEN CREEK RD SUITE 109
GILBERT AZ
85297-8501
US

IV. Provider business mailing address

4771 E MEADOW LARK WAY
QUEEN CREEK AZ
85240-5207
US

V. Phone/Fax

Practice location:
  • Phone: 480-621-8361
  • Fax: 480-621-8513
Mailing address:
  • Phone: 480-830-2445
  • Fax: 480-677-8921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number5899
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: