Provider Demographics
NPI:1003068438
Name:MARSHALL, PETER L (PT)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:L
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1303
Mailing Address - Street 2:
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-1303
Mailing Address - Country:US
Mailing Address - Phone:970-318-1118
Mailing Address - Fax:
Practice Address - Street 1:219 NORTH ALDER STREET
Practice Address - Street 2:
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435-1303
Practice Address - Country:US
Practice Address - Phone:970-318-1118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1899225100000X
CAPT 16683225100000X
NY003790-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist