Provider Demographics
NPI:1699968818
Name:THOMAS, MARISA VICTORIA (MPT)
Entity type:Individual
Prefix:MS
First Name:MARISA
Middle Name:VICTORIA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 MANOR AVE
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-2943
Mailing Address - Country:US
Mailing Address - Phone:215-757-7667
Mailing Address - Fax:215-750-1426
Practice Address - Street 1:350 MANOR AVE
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-2943
Practice Address - Country:US
Practice Address - Phone:215-757-7667
Practice Address - Fax:215-750-1426
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist