Provider Demographics
NPI:1134363567
Name:VICTORIO, MARISSA (PT)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:VICTORIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:V
Other - Last Name:VICTORIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:8047 268TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11004
Mailing Address - Country:US
Mailing Address - Phone:516-263-0418
Mailing Address - Fax:516-232-9554
Practice Address - Street 1:8047 268TH ST
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11004
Practice Address - Country:US
Practice Address - Phone:516-263-0418
Practice Address - Fax:516-232-9554
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist