Provider Demographics
NPI:1669058467
Name:MARINO, REBEKAH (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:MARINO
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 MOTOR PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:28-12 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3924
Practice Address - Country:US
Practice Address - Phone:201-475-8482
Practice Address - Fax:210-475-8139
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047173-01225100000X
NJ40QA01997200225100000X
DEJ1-0014425225100000X
MD28407225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist