MEDICARE: MARC-STEVE DESTIN

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	225200000X	Physical Therapy Assistant	PTA30567	FL

General Provider Information

NPI Number	:	1992465553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC-STEVE DESTIN

Provider Business Mailing Address
First Line	:	12026 ROYAL PALM BLVD
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-3379
Country	:	US
Telephone Number	:	954-415-3258
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 W SAMPLE RD
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33064-3542
Country	:	US
Telephone Number	:	954-942-5530
Fax Number	:

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

Provider Enumeration Date	:	12/23/2021
Last Update Date	:	12/23/2021

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Directions to “ MARC-STEVE DESTIN ” Practice Location

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