Most Relevant Information
Provider Data
| NPI Number: | 1003420589 |
| Provider Name: | MARISSA JOY NAZARENO DPT |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | 5501019682 |
Most Important Dates
| Enumeration Date: | 09/02/2020 |
| Last Updated: | 03/22/2024 |
Provider Practice Location
20059 KING RD
WOODHAVEN
MI
481831032
Practice Location Phone/Fax
| Phone: | 7343655112 |
| Fax: | 7343655115 |
Provider Mailing Location
33900 HARPER AVE STE 104
CLINTON TWP
MI
480354258
Provider Mailing Phone/Fax
| Phone: | 5863502644 |
| Fax: | 5865413735 |