MEDICARE: MARYANN MARCHETTA PHYSICAL THERAPIST

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	PT20092	FL

General Provider Information

NPI Number	:	1649290677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYANN MARCHETTA PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	3230 LAKE WORTH RD STE C
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-3694
Country	:	US
Telephone Number	:	561-968-7788
Fax Number	:

Provider Business Practice Location Address
First Line	:	3230 LAKE WORTH RD STE C
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461
Country	:	US
Telephone Number	:	561-968-7788
Fax Number	:

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	01/31/2019

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