Healthcare Provider Details

I. General information

NPI: 1619246352
Provider Name (Legal Business Name): THAI MARSICO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 UPLAND AVE
HORSHAM PA
19044-2550
US

IV. Provider business mailing address

239 UPLAND AVE
HORSHAM PA
19044-2550
US

V. Phone/Fax

Practice location:
  • Phone: 267-694-9834
  • Fax:
Mailing address:
  • Phone: 267-694-9834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT020702
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: