Provider Demographics
NPI:1073947099
Name:BRISCOE, MARINA LEIGH (DPT)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:LEIGH
Last Name:BRISCOE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22659 PACIFIC HWY S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-5155
Mailing Address - Country:US
Mailing Address - Phone:206-824-3668
Mailing Address - Fax:206-824-3964
Practice Address - Street 1:22659 PACIFIC HWY S
Practice Address - Street 2:SUITE 201
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-5155
Practice Address - Country:US
Practice Address - Phone:206-824-3668
Practice Address - Fax:206-824-3964
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1231678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist