Healthcare Provider Details

I. General information

NPI: 1265917405
Provider Name (Legal Business Name): MARISA FEMIA R-DMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 PARK AVE
NEW YORK NY
10035-1316
US

IV. Provider business mailing address

1841 PARK AVE
NEW YORK NY
10035-1316
US

V. Phone/Fax

Practice location:
  • Phone: 646-459-6091
  • Fax:
Mailing address:
  • Phone: 646-459-6091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: