Healthcare Provider Details

I. General information

NPI: 1295726487
Provider Name (Legal Business Name): LEE N MARINKO PT,OCS,FAAOMPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUMMINGS CTR SUITE 121Q
BEVERLY MA
01915-6115
US

IV. Provider business mailing address

250 MAPLE ST
DANVERS MA
01923-1517
US

V. Phone/Fax

Practice location:
  • Phone: 978-774-9896
  • Fax:
Mailing address:
  • Phone: 978-774-9896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number6096
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: