Provider Demographics
NPI:1407975931
Name:MARSHALL, AMY M (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 WOODMERE PARK BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-5373
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4120 WOODMERE PARK BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5373
Practice Address - Country:US
Practice Address - Phone:941-408-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056000225100000X
FL25319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist