MEDICARE: LESLIE K MARCKS 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	225100000X	Physical Therapist	40QA00399600	NJ

General Provider Information

NPI Number	:	1487638995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE K MARCKS PT

Provider Business Mailing Address
First Line	:	106 SUNSET AVE
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540-8532
Country	:	US
Telephone Number	:	732-785-0040
Fax Number	:	732-785-0265

Provider Business Practice Location Address
First Line	:	180 TICES LN
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-1345
Country	:	US
Telephone Number	:	908-962-7689
Fax Number	:	732-785-0265

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	09/18/2018

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