Marissa Lilliana Biclawski
Individual provider Active NPI Physical Therapist · Mantua, OH
NPI 1073344396 · NPPES record last updated Aug 8, 2024
Key facts
- NPI
- 1073344396
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT019482 (OH)
- Practice address
- 10600 Peck Rd
Mantua, OH 44255-9505 - Phone
- (330) 221-7634
- NPI assigned
- Aug 8, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT019482 | OH | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT019482 | OH | Yes |
Addresses
Primary practice location
10600 Peck Rd
Mantua, OH 44255-9505
Mailing address
10600 Peck Rd
Mantua, OH 44255-9505
Phone (330) 221-7634
Other providers in Mantua, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.