Provider Demographics
NPI:1285255372
Name:GELINAS, MARC
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:GELINAS
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 1:1710 EGRET LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-5800
Mailing Address - Country:US
Mailing Address - Phone:817-821-5494
Mailing Address - Fax:
Practice Address - Street 1:1710 EGRET LN
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-5800
Practice Address - Country:US
Practice Address - Phone:817-821-5494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1082683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1082683OtherTEXAS PHYSICAL THERAPY LICENSE NUMBER
NCP627OtherNORTH CAROLINA PHYSICAL THERAPY LICENSE