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General NPI Number Information
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NPI Number | 1871932053
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Entity Type | Individual
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Provider Name | MELANIE MARINO PTA
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Gender | Female
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Dates
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Enumeration Date | 06/20/2013
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Last Update Date | 06/20/2013
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Provider Practice Location Address
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Address Line | 864 US HIGHWAY 158 BUS W
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City | WARRENTON
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State | NC
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Zip | 27589-9789
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Country | US
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Telephone | 252-257-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 3413 BUCK RUN TRL
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City | WAKE FOREST
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State | NC
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Zip | 27587-8851
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Country | US
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Telephone | 301-408-8077
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5098
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License Number State | NC
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