MEDICARE: MR. MARC ANTHONY VASIL PT

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
1	2251S0007X	Sports Physical Therapist	PT09270	OH
2	2251X0800X	Orthopedic Physical Therapist	PT09270	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215023072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARC ANTHONY VASIL PT

Provider Business Mailing Address
First Line	:	PO BOX 361098
Second Line	:
City	:	STRONGSVILLE
State	:	OH
Zip	:	44136-0019
Country	:	US
Telephone Number	:	440-229-5822
Fax Number	:	440-448-4902

Provider Business Practice Location Address
First Line	:	5813 MAYFIELD RD
Second Line	:	SUITE 202
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-2932
Country	:	US
Telephone Number	:	440-229-5822
Fax Number	:	440-448-4902

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	08/02/2023

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