Jacob Lance Marino, PT, DPT | |
12627 Airline Hwy, Destrehan, LA 70047-2550 | |
(985) 603-4157 | |
(985) 603-4242 |
Full Name | Jacob Lance Marino |
---|---|
Gender | Male |
Speciality | Physical Therapist |
Location | 12627 Airline Hwy, Destrehan, Louisiana |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1316722044 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | 10938 (Louisiana) | Primary |
Provider Name | Physiofit Physical Therapy, Llc |
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Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
Provider Identifiers | NPI Number: 1699111674 PECOS PAC ID: 3274767702 Enrollment ID: O20131016000232 |
Mailing Address | Practice Location Address |
---|---|
Jacob Lance Marino, PT, DPT 1200 Corporate Dr Ste 400, Hoover, AL 35242-5424 Ph: (423) 238-7217 | Jacob Lance Marino, PT, DPT 12627 Airline Hwy, Destrehan, LA 70047-2550 Ph: (985) 603-4157 |
Wesley Malcolm Juneau, PT, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 12627 Airline Hwy Ste A, Destrehan, LA 70047 Phone: 985-603-4157 Fax: 985-603-4242 | |
Cody Migliore, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 1972 Ormond Blvd, Destrehan, LA 70047 Phone: 985-307-0925 | |
Patrick Lawrence Childress, D.P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1972 Ormond Blvd, Destrehan, LA 70047 Phone: 985-307-0925 | |
William James Smith, PT, DPT, OCS, CSCS Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1972 Ormond Blvd, Destrehan, LA 70047 Phone: 985-307-0925 | |
Brandon Kyle Robichaux, Physical Therapist Medicare: Medicare Enrolled Practice Location: 4 Edgewood Dr, Destrehan, LA 70047 Phone: 504-559-7054 | |
Physiofit - Destrehan, La Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 12627 Airline Hwy Ste A, Destrehan, LA 70047 Phone: 985-603-4157 Fax: 985-603-4242 |