Healthcare Provider Details

I. General information

NPI: 1164573895
Provider Name (Legal Business Name): MARNI TARA KANZE MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SPRINGHOUSE LANE
COLLEGEVILLE PA
19426
US

IV. Provider business mailing address

3809 W CHESTER PIKE STE 150
NEWTOWN SQUARE PA
19073-0259
US

V. Phone/Fax

Practice location:
  • Phone: 610-489-4745
  • Fax: 610-489-4209
Mailing address:
  • Phone: 610-359-5671
  • Fax: 610-359-1519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT015403
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: