Marielle Blackburn, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

030619 Issued in NY

Practice address

785 Mamaroneck Ave
White Plains, NY 10605-2523

Phone

(914) 597-2882

NPI assigned

Dec 12, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2008

Medicare assignment

May accept Medicare assignment

Group practices

Handd Dynamic Physical and Occupational Therapy, PLLCGroup PAC ID 7416132634, 45 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• H&D Dynamic Physical & Occupational Therapy, PLLC

  • Physical Therapist
  • New York, NY
  • NPI 1699926139

  NY, Physical Therapist

  Medicare reassignment Care Compare group NPD
• H&D Physical Therapy & Occupational Therapy PLLC

  • Physical Therapist
  • New York, NY
  • NPI 1235174228

  NY, Physical Therapist

  Medicare reassignment NPD
• Outreach Physical and Occupational Therapy & Speech Rehabilitation, PLLC

  • Physical Therapist
  • Great Neck, NY
  • NPI 1841526399

  NY, Physical Therapist

  Medicare reassignment NPD

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

{
    "created_epoch": "1576108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576108800000",
    "number": "1659919397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "785 MAMARONECK AVE",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106052523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "785 MAMARONECK AVE",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106052523",
            "telephone_number": "914-597-2882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "MARIELLE",
        "name_prefix": "Dr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-12",
        "last_updated": "2019-12-12",
        "certification_date": "2019-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "030619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• BJ'S Wholesale Club Inc.
• Elaine Black, LCSW-R
• Lisa Black, CASAC-2
• Merrill Black, L.C.S.W.
• Tracy Ann Black
• April Neuman Blacker, M.A. CCC
• Fitzroy Blackstock
• Bryan Paul Blair, MD
• Charleen Blair
• Tamar Blanchard, PH.D.

• Physical Therapist in White Plains, NY
• Providers in White Plains, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2019; 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.