Provider Demographics
NPI:1427002328
Name:BUNNELL, MARILYN L (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:L
Last Name:BUNNELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:MARILYN
Other - Middle Name:L
Other - Last Name:SHOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1312 DRAKE RIDGE CRES
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6519
Mailing Address - Country:US
Mailing Address - Phone:909-793-3311
Mailing Address - Fax:909-796-4158
Practice Address - Street 1:245 TERRACINA BLVD
Practice Address - Street 2:STE. 105
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4852
Practice Address - Country:US
Practice Address - Phone:909-792-9737
Practice Address - Fax:909-796-4158
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist