Provider Demographics
NPI:1427504612
Name:ASTA, MARC (DPT)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:ASTA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CHARLOIS BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1562
Mailing Address - Country:US
Mailing Address - Phone:363-765-5664
Mailing Address - Fax:336-768-6713
Practice Address - Street 1:120 CHARLOIS BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1562
Practice Address - Country:US
Practice Address - Phone:336-765-5664
Practice Address - Fax:336-768-6713
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP18465225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist