Provider Demographics
NPI:1164483616
Name:MARQUARDT, KRISTA (MPT, CHT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:
Last Name:MARQUARDT
Suffix:
Gender:F
Credentials:MPT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5976 W MONTEVISTA DR
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-2703
Mailing Address - Country:US
Mailing Address - Phone:810-385-1364
Mailing Address - Fax:
Practice Address - Street 1:940 RIVER CENTRE DR
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-4463
Practice Address - Country:US
Practice Address - Phone:810-985-7412
Practice Address - Fax:810-985-4981
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist