Individual
MS. MARIE CUSTODERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
550 EASTGATE DR, AIKEN, SC 29803
(803) 643-3694
Mailing address
4 W RED OAK LN STE 201, WHITE PLAINS, NY 10604-3603
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
887462000
—
FL
Enumeration date
05/02/2007
Last updated
09/11/2019
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