Provider Demographics
NPI:1154501054
Name:DE MONS, MARSHAWN RENEE (DPT)
Entity Type:Individual
Prefix:
First Name:MARSHAWN
Middle Name:RENEE
Last Name:DE MONS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARSHAWN
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:425 KEARNEY ST
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-3656
Mailing Address - Country:US
Mailing Address - Phone:510-524-2177
Mailing Address - Fax:
Practice Address - Street 1:425 KEARNEY ST
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-3656
Practice Address - Country:US
Practice Address - Phone:510-524-2177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist