MEDICARE: MS. HOLLY BETH MARVEL 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
1	2251G0304X	Geriatric Physical Therapist
2	225100000X	Physical Therapist	007495	CT

General Provider Information

NPI Number	:	1912247271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOLLY BETH MARVEL P.T.

Provider Business Mailing Address
First Line	:	103 NORTH RD
Second Line	:
City	:	WINDHAM
State	:	CT
Zip	:	06280-1311
Country	:	US
Telephone Number	:	860-423-4636
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 NORTH RD
Second Line	:
City	:	WINDHAM
State	:	CT
Zip	:	06280-1311
Country	:	US
Telephone Number	:	860-423-4636
Fax Number	:

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

Provider Enumeration Date	:	02/25/2013
Last Update Date	:	04/17/2023

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