Provider Demographics
NPI:1336505403
Name:DIONSON, MARQUIS (PTA)
Entity Type:Individual
Prefix:MR
First Name:MARQUIS
Middle Name:
Last Name:DIONSON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8128 DEMUI WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-6205
Mailing Address - Country:US
Mailing Address - Phone:916-280-8385
Mailing Address - Fax:
Practice Address - Street 1:4700 NORTHGATE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1128
Practice Address - Country:US
Practice Address - Phone:916-929-6161
Practice Address - Fax:916-929-1533
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT11107225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant