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NPI Code Detail

MEDICARE: VINCENT MARINO JR. P.T.

MEDICARE: VINCENT MARINO JR. P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist015543NY

General Provider Information

NPI Number : 1184686636
Entity Type Code : Individual
Provider Name (Legal Business Name) : VINCENT MARINO JR. P.T.
Provider Business Mailing Address
First Line : 231 WALTON ST
Second Line : SUITE 200
City : SYRACUSE
State : NY
Zip : 13202-1230
Country : US
Telephone Number : 315-478-0380
Fax Number : 315-478-0388
Provider Business Practice Location Address
First Line : 5719 WIDEWATERS PKWY
Second Line :
City : DE WITT
State : NY
Zip : 13214-1880
Country : US
Telephone Number : 315-449-1301
Fax Number : 315-449-2707
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2006
Last Update Date : 04/15/2008

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