Provider Demographics
NPI:1356832315
Name:TURNER, MARVIN W (PTA)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:W
Last Name:TURNER
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 1:350 NW 134TH AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2251
Mailing Address - Country:US
Mailing Address - Phone:443-354-2451
Mailing Address - Fax:
Practice Address - Street 1:12251 TAFT ST STE 302
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-1956
Practice Address - Country:US
Practice Address - Phone:954-951-0974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLPTA27890225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLLPTA27890Medicaid