Individual provider Active NPI

Marissa Cancilla, PT

  • Physical Therapist
  • North Canton, OH
National Provider Identifier
1346533916
Registry record updated May 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT. 09464 Issued in OH
Practice address
339 E Maple St
North Canton, OH 44720-2593
Phone
(330) 498-8239
NPI assigned
May 16, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT. 09464 OH Primary

Addresses

Primary practice location

339 E Maple St
North Canton, OH 44720-2593

Mailing address

339 E Maple St
North Canton, OH 44720-2593
Phone (330) 498-8239

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200928000899 OH Practitioner - Physical Therapist in Private Practice 1557780400 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Healthpro Heritage Rehab and Fitness LLCGroup PAC ID 6507832573, 976 clinicians

Practice addresses (Care Compare)

4 Berea CMNS
Berea, OH 44017-2524
Phone (440) 399-6302

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT. 09464OHMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Healthpro Heritage Rehab & Fitness, LLC Physical Therapist CurrentSince Sep 8, 2025 Accepting new patients
Healthpro Heritage Rehab & Fitness, LLC Physical Therapist CurrentSince Sep 8, 2025 Accepting new patients

Locations

4 Berea Cmns
Berea, OH 44017
Phone (440) 243-9050

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1305504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305504000000",
    "number": "1346533916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "339 E MAPLE ST",
            "city": "NORTH CANTON",
            "state": "OH",
            "postal_code": "447202593",
            "telephone_number": "330-498-8239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 E MAPLE ST",
            "city": "NORTH CANTON",
            "state": "OH",
            "postal_code": "447202593",
            "telephone_number": "330-498-8239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANCILLA",
        "first_name": "MARISSA",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-16",
        "last_updated": "2011-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "PT. 09464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Canton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.