Healthcare Provider Details

I. General information

NPI: 1841564549
Provider Name (Legal Business Name): MARISSA SCHUBERT D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISSA CARRATELLO

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 E 4TH ST STE 170
SANTA ANA CA
92705-3814
US

IV. Provider business mailing address

200 NEWPORT CENTER DR
NEWPORT BEACH CA
92660-7501
US

V. Phone/Fax

Practice location:
  • Phone: 714-558-3977
  • Fax: 714-558-0308
Mailing address:
  • Phone: 562-777-1333
  • Fax: 562-777-1347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 38809
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: