Provider Demographics
NPI:1184300337
Name:SARDELA, MARCO
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:
Last Name:SARDELA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5818 N PENNSYLVANIA AVE APT 210B
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7489
Mailing Address - Country:US
Mailing Address - Phone:217-419-5673
Mailing Address - Fax:
Practice Address - Street 1:5818 N PENNSYLVANIA AVE APT 210B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7489
Practice Address - Country:US
Practice Address - Phone:217-419-5673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist