1538210893 NPI number — MARRIANNE F NEALE PT

Table of content: MARRIANNE F NEALE PT (NPI 1538210893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538210893 NPI number — MARRIANNE F NEALE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEALE
Provider First Name:
MARRIANNE
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538210893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 NEWPORT CENTER DR
Provider Second Line Business Mailing Address:
SUITE 213
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92660-7501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-644-1322
Provider Business Mailing Address Fax Number:
949-644-0316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 MAUCHLY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92618-2393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-727-3315
Provider Business Practice Location Address Fax Number:
949-727-3624
Provider Enumeration Date:
01/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT 32143 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT 32143 . This is a "PHYSICAL THERAPY LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: WPT32143A . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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