Provider Demographics
NPI:1417279688
Name:MARSH, MARIAH DIANA (DPT)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:DIANA
Last Name:MARSH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4572 TELEPHONE RD STE 903
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5663
Mailing Address - Country:US
Mailing Address - Phone:805-654-8127
Mailing Address - Fax:805-654-8149
Practice Address - Street 1:4572 TELEPHONE RD STE 903
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5663
Practice Address - Country:US
Practice Address - Phone:805-654-8127
Practice Address - Fax:805-654-8149
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA358922251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic