Healthcare Provider Details

I. General information

NPI: 1326070566
Provider Name (Legal Business Name): MATTHEW MARINO P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 VILLAGE PLZ
DANSVILLE NY
14437-9260
US

IV. Provider business mailing address

PO BOX 693
MENDON NY
14506-0693
US

V. Phone/Fax

Practice location:
  • Phone: 585-335-2456
  • Fax: 585-335-3494
Mailing address:
  • Phone: 585-851-9987
  • Fax: 585-335-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number025405-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: