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NPI Code Detail

MEDICARE: MS. BONNIE A. MARIETTA P.T.

MEDICARE: MS. BONNIE A. MARIETTA 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 Therapist009478-1NY

General Provider Information

NPI Number : 1639203797
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BONNIE A. MARIETTA P.T.
Provider Business Mailing Address
First Line : 68 RADCLIFFE RD FL 1
Second Line :
City : ISLAND PARK
State : NY
Zip : 11558-2154
Country : US
Telephone Number : 516-946-9310
Fax Number :
Provider Business Practice Location Address
First Line : 1770 STILLWELL AVE
Second Line :
City : BRONX
State : NY
Zip : 10469-6409
Country : US
Telephone Number : 718-652-9790
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2007
Last Update Date : 05/27/2026

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