Healthcare Provider Details

I. General information

NPI: 1033802640
Provider Name (Legal Business Name): ANDREW MARZAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 ELM ST
EVERETT MA
02149-5228
US

IV. Provider business mailing address

36 BONAIR ST APT 1
SOMERVILLE MA
02145-3160
US

V. Phone/Fax

Practice location:
  • Phone: 617-387-6560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: