1699759811 NPI number — MRS. ALICIA MARBLO MCMASTERS PT, CSCS

Table of content: MRS. ALICIA MARBLO MCMASTERS PT, CSCS (NPI 1699759811)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699759811 NPI number — MRS. ALICIA MARBLO MCMASTERS PT, CSCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCMASTERS
Provider First Name:
ALICIA
Provider Middle Name:
MARBLO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT, CSCS
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:
1699759811
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8220 UNIVERSITY EXEC PARK DR
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28262-3380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-547-1129
Provider Business Mailing Address Fax Number:
704-547-9056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8220 UNIVERSITY EXEC PARK DR
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28262-3380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-547-1129
Provider Business Practice Location Address Fax Number:
704-547-9056
Provider Enumeration Date:
12/01/2005

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: 2251X0800X , with the licence number:  9486 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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