Provider Demographics
NPI:1538210893
Name:NEALE, MARRIANNE F (PT)
Entity type:Individual
Prefix:
First Name:MARRIANNE
Middle Name:F
Last Name:NEALE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 NEWPORT CENTER DR
Mailing Address - Street 2:SUITE 213
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7501
Mailing Address - Country:US
Mailing Address - Phone:949-644-1322
Mailing Address - Fax:949-644-0316
Practice Address - Street 1:36 MAUCHLY
Practice Address - Street 2:SUITE A
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2393
Practice Address - Country:US
Practice Address - Phone:949-727-3315
Practice Address - Fax:949-727-3624
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 32143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 32143OtherPHYSICAL THERAPY LICENSE
CAWPT32143AOtherMEDICARE PTAN