Active NPI
Marissa M Hanlon, PT
- Physical Therapist
- Fulton, NY
National Provider Identifier
1962859553
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 026602-1
- Practice address
- 10 Canalview Mall
Suite C
Fulton, NY 13069-1838 - Phone
- (315) 593-8786
- Fax
- (315) 598-5538
- NPI assigned
- May 24, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 026602-1 | NY | Primary |
Addresses
Primary practice location
10 Canalview Mall
Suite C
Fulton, NY 13069-1838
Mailing address
10 Canalview Mall
Suite C
Fulton, NY 13069-1838
Phone (315) 593-8786
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 026602-1 | NY | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Primary Physical Therapy PLLC | Physical Therapist | Past | Accepting new patients |
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.
-
dba PROActive Physical therapy
- Physical Therapist
- North Syracuse, NY
- NPI 1922071257
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464048000000",
"number": "1962859553",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 CANALVIEW MALL",
"address_2": "SUITE C",
"city": "FULTON",
"state": "NY",
"postal_code": "130691838",
"telephone_number": "315-593-8786",
"fax_number": "315-598-5538"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 CANALVIEW MALL",
"address_2": "SUITE C",
"city": "FULTON",
"state": "NY",
"postal_code": "130691838",
"telephone_number": "315-593-8786",
"fax_number": "315-598-5538"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANLON",
"first_name": "MARISSA",
"middle_name": "M",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-05-24",
"last_updated": "2016-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "026602-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fulton, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.