NPIMap

Organization Active NPI

Coburn a. Marston, PT

Doing business as Magnolia Physical Therapy

  • Physical Therapy Clinic/Center
  • Leesburg, FL
National Provider Identifier
1659591568
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT1647 Issued in FL
Legal business name
COBURN A. MARSTON, PT
Doing business as
Magnolia Physical Therapy
Practice address
101 S 11TH St
Suite 3
Leesburg, FL 34748-5767
Phone
(352) 787-3609
Fax
(352) 314-8979
NPI assigned
Apr 26, 2007
Last updated
Jun 17, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2008

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

Authorized official

Name
Mr. Coburn Arthur Marston, PTNPI 1376564526
Title
Owner
Phone
(352) 787-3609

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X PT1647 FL Primary

Addresses

Primary practice location

101 S 11TH St
Suite 3
Leesburg, FL 34748-5767

Mailing address

101 S 11TH St
Suite 3
Leesburg, FL 34748-5767
Phone (352) 787-3609

Other names 1

  • Magnolia Physical Therapy Doing business as

National Provider Directory

National Provider Directory

Locations

101 S 11th St
Ste 3
Leesburg, FL 34748
Phone (352) 787-3609

26540 Ace Ave
Ste B
Leesburg, FL 34748
Phone (352) 314-9810

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1659591568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 S 11TH ST",
            "address_2": "SUITE 3",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485767",
            "telephone_number": "352-787-3609",
            "fax_number": "352-314-8979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S 11TH ST",
            "address_2": "SUITE 3",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485767",
            "telephone_number": "352-787-3609",
            "fax_number": "352-314-8979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COBURN A. MARSTON, PT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-26",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "MARSTON",
        "authorized_official_first_name": "COBURN",
        "authorized_official_middle_name": "ARTHUR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-787-3609",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "FL",
            "license": "PT1647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magnolia Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Leesburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.