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NPI Code Detail

MEDICARE: MARILYN GLEESON PTA

MEDICARE: MARILYN GLEESON PTA
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
1225200000XPhysical Therapy Assistant2306001251VA

General Provider Information

NPI Number : 1477096618
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILYN GLEESON PTA
Provider Business Mailing Address
First Line : 542 WALNUT HILLS RD
Second Line :
City : STAUNTON
State : VA
Zip : 24401-6935
Country : US
Telephone Number : 540-337-1999
Fax Number : 540-337-9618
Provider Business Practice Location Address
First Line : 542 WALNUT HILLS RD
Second Line :
City : STAUNTON
State : VA
Zip : 24401-6935
Country : US
Telephone Number : 540-337-1999
Fax Number : 540-337-9618
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2016
Last Update Date : 11/21/2016

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