MEDICARE: MARISSA BECHTOLD DPT

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	014147	OH

General Provider Information

NPI Number	:	1497198386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA BECHTOLD DPT

Provider Business Mailing Address
First Line	:	61 OBRIEN DR
Second Line	:
City	:	LOCKPORT
State	:	NY
Zip	:	14094-5112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14900 PRIVATE DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44112-3470
Country	:	US
Telephone Number	:	216-851-8200
Fax Number	:

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

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	04/10/2013

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Directions to “ MARISSA BECHTOLD DPT” Practice Location

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