Provider Demographics
NPI:1891836938
Name:MARABELLA-PECK, ELIZABETH ANN (PT, DPT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:MARABELLA-PECK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-5308
Mailing Address - Country:US
Mailing Address - Phone:716-692-6388
Mailing Address - Fax:716-692-1227
Practice Address - Street 1:105 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-5308
Practice Address - Country:US
Practice Address - Phone:716-692-6388
Practice Address - Fax:716-692-1227
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2012-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17364-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC1358Medicare ID - Type Unspecified