Provider Demographics
NPI:1235747569
Name:MARSHALL, ELIZABETH LAWRENCE (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LAWRENCE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2432 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-4921
Mailing Address - Country:US
Mailing Address - Phone:909-720-0518
Mailing Address - Fax:
Practice Address - Street 1:2151 E CONVENTION CENTER WAY
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-5429
Practice Address - Country:US
Practice Address - Phone:909-573-7442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32151225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist