Individual provider Active NPI

Elizabeth Ann Marabella-Peck, PT, DPT

  • Physical Therapist
  • North Tonawanda, NY
National Provider Identifier
1891836938
Registry record updated Aug 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
17364-1 Issued in NY
Practice address
105 Main St
Suite 2
North Tonawanda, NY 14120-5308
Phone
(716) 692-6388
Fax
(716) 692-1227
NPI assigned
Feb 10, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2012

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 17364-1 NY Primary

Addresses

Primary practice location

105 Main St
Suite 2
North Tonawanda, NY 14120-5308

Mailing address

105 Main St
Suite 2
North Tonawanda, NY 14120-5308
Phone (716) 692-6388

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100327000045 NY Practitioner - Physical Therapist in Private Practice 6002942240 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
17364-1NYMDPhysical Therapist

Organizations & group practices 1

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": "1171065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345939200000",
    "number": "1891836938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 MAIN ST",
            "address_2": "SUITE 2",
            "city": "NORTH TONAWANDA",
            "state": "NY",
            "postal_code": "141205308",
            "telephone_number": "716-692-6388",
            "fax_number": "716-692-1227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 MAIN ST",
            "address_2": "SUITE 2",
            "city": "NORTH TONAWANDA",
            "state": "NY",
            "postal_code": "141205308",
            "telephone_number": "716-692-6388",
            "fax_number": "716-692-1227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARABELLA-PECK",
        "first_name": "ELIZABETH",
        "middle_name": "ANN",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-10",
        "last_updated": "2012-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "17364-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Tonawanda, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.