Provider Demographics
NPI:1225582943
Name:MARSHALL, JUSTIN (DPT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8862 BENDER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-8800
Mailing Address - Country:US
Mailing Address - Phone:360-354-1115
Mailing Address - Fax:
Practice Address - Street 1:1740 LABOUNTY DR
Practice Address - Street 2:SUITE 7
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9403
Practice Address - Country:US
Practice Address - Phone:360-384-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60648316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist