=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528390242
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARLON CHUAH BIRREY PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2010
-----------------------------------------------------
Last Update Date | 03/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2888 RINGLING BLVD UNIT C&D
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34237-5331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-319-8335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12292 LONGVIEW LAKE CIR
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34211-4965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-319-8335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT25327
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------