Healthcare Provider Details

I. General information

NPI: 1659605624
Provider Name (Legal Business Name): MARC JOSEPH ESCARILLA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MAPLE ST
NORWALK CT
06850-3815
US

IV. Provider business mailing address

14 BITTERSWEET LN
TRUMBULL CT
06611-2365
US

V. Phone/Fax

Practice location:
  • Phone: 203-852-2000
  • Fax:
Mailing address:
  • Phone: 786-301-5760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number006601
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: