Provider Demographics
NPI:1538216874
Name:NEESEN, MARCEL V (PT)
Entity type:Individual
Prefix:MR
First Name:MARCEL
Middle Name:V
Last Name:NEESEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3699 WATERCREST DR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-2357
Mailing Address - Country:US
Mailing Address - Phone:407-862-8329
Mailing Address - Fax:
Practice Address - Street 1:686 N HUNT CLUB BLVD STE 180
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-2218
Practice Address - Country:US
Practice Address - Phone:407-772-4515
Practice Address - Fax:407-772-4518
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5965ZMedicare ID - Type Unspecified