Provider Demographics
NPI:1467500934
Name:MARSHALL, MARK (DPT, PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 S EAST AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2411
Mailing Address - Country:US
Mailing Address - Phone:517-990-6211
Mailing Address - Fax:517-990-6212
Practice Address - Street 1:480 OLDS ST
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:MI
Practice Address - Zip Code:49250-9433
Practice Address - Country:US
Practice Address - Phone:517-849-7040
Practice Address - Fax:517-849-7050
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2255A2300X
MI5501019021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer