1881916005 NPI number — MARISSA NICOLE SENDOWSKY DPT, PT, ATC

Table of content: MARISSA NICOLE SENDOWSKY DPT, PT, ATC (NPI 1881916005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881916005 NPI number — MARISSA NICOLE SENDOWSKY DPT, PT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SENDOWSKY
Provider First Name:
MARISSA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT, PT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TICE
Provider Other First Name:
MARISSA
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881916005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4900 E CHAPMAN AVE
Provider Second Line Business Mailing Address:
UNIT 13
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92869-4116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-624-2069
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 E GOLDEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLACENTIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92870-1635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-993-2093
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/16/2010

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: 2251P0200X , with the licence number:  PT36352 , 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)





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