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General NPI Number Information
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NPI Number | 1104960343
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Entity Type | Individual
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Provider Name | MARIETTA JOANNE PHILLIPS PT
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Gender | Female
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 2755 BUFFALO RD
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City | ROCHESTER
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State | NY
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Zip | 14624-1304
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Country | US
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Telephone | 585-290-1490
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Fax |
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Provider Business Mailing Address
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Address Line | 45 TELLIDORA TRL
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City | SPENCERPORT
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State | NY
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Zip | 14559-9404
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Country | US
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Telephone | 585-293-1285
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 012008-1
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License Number State | NY
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