Provider Demographics
NPI:1144821505
Name:MARSICANO, PETER IV (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:MARSICANO
Suffix:IV
Gender:M
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 1:10 GALLOPING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08501-2027
Mailing Address - Country:US
Mailing Address - Phone:609-658-7687
Mailing Address - Fax:
Practice Address - Street 1:293 ROUTE 206 UNIT 10
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-9580
Practice Address - Country:US
Practice Address - Phone:908-955-0071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01948400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist