Healthcare Provider Details

I. General information

NPI: 1609293745
Provider Name (Legal Business Name): CHRISTINE MARCINOWSKI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21225 LORAIN RD
FAIRVIEW PARK OH
44126-2120
US

IV. Provider business mailing address

21225 LORAIN RD
FAIRVIEW PARK OH
44126-2120
US

V. Phone/Fax

Practice location:
  • Phone: 440-331-3180
  • Fax: 440-331-3183
Mailing address:
  • Phone: 440-331-3180
  • Fax: 440-331-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number005958
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: