Provider Demographics
NPI:1225163629
Name:MARQUEZ, TANYA (ATC, CSCS)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 GRENWICH HL
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-9366
Mailing Address - Country:US
Mailing Address - Phone:431-323-4587
Mailing Address - Fax:
Practice Address - Street 1:291 SPRINGFIELD ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-2837
Practice Address - Country:US
Practice Address - Phone:413-265-2417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer