Provider Demographics
NPI:1457080541
Name:ELQUIST, MARISSA (DPT)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:ELQUIST
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 1:15 MCCABE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-4815
Mailing Address - Country:US
Mailing Address - Phone:775-788-5599
Mailing Address - Fax:775-788-5595
Practice Address - Street 1:15 MCCABE DR STE 101
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-4815
Practice Address - Country:US
Practice Address - Phone:775-788-5599
Practice Address - Fax:775-788-5595
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4868225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist