Provider Demographics
NPI:1053913988
Name:MOSCONE, MARINA (DPT)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:MOSCONE
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 BANGOR MALL BLVD # 1082
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3632
Mailing Address - Country:US
Mailing Address - Phone:207-640-6185
Mailing Address - Fax:
Practice Address - Street 1:2263 ROUTE 2
Practice Address - Street 2:
Practice Address - City:HERMON
Practice Address - State:ME
Practice Address - Zip Code:04401-0605
Practice Address - Country:US
Practice Address - Phone:207-848-9009
Practice Address - Fax:207-404-2562
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT4917225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist