Healthcare Provider Details

I. General information

NPI: 1811224306
Provider Name (Legal Business Name): MARY ELIZABETH MARCINKOWSKI P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GREENLEAF WOODS DR SUITE 101
PORTSMOUTH NH
03801-5437
US

IV. Provider business mailing address

1 GREENLEAF WOODS DR SUITE 101
PORTSMOUTH NH
03801-5437
US

V. Phone/Fax

Practice location:
  • Phone: 603-319-8334
  • Fax: 603-431-2940
Mailing address:
  • Phone: 603-319-8334
  • Fax: 603-431-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0714
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number0714
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number0714
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: