Healthcare Provider Details

I. General information

NPI: 1265972772
Provider Name (Legal Business Name): MARCHETTI PHYSICAL MEDICINE P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4944 PRESTON RD STE 100A
FRISCO TX
75034-8987
US

IV. Provider business mailing address

4944 PRESTON RD SUITE 100A
FRISCO TX
75034-8597
US

V. Phone/Fax

Practice location:
  • Phone: 469-304-3443
  • Fax: 469-304-3443
Mailing address:
  • Phone: 469-304-3443
  • Fax: 469-304-3443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberL7470
License Number StateTX

VIII. Authorized Official

Name: JASON MARCHETTI
Title or Position: OWNER
Credential: M.D.
Phone: 469-304-3443