Provider Demographics
NPI:1043505134
Name:MARQUARDT, ERIC DANIEL (PT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:DANIEL
Last Name:MARQUARDT
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 1:3826 44TH ST SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49512-3919
Mailing Address - Country:US
Mailing Address - Phone:616-554-0918
Mailing Address - Fax:616-554-3079
Practice Address - Street 1:5581 KATHERINE CT
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3624
Practice Address - Country:US
Practice Address - Phone:989-827-9218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010156032251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic