Provider Demographics
NPI:1477839611
Name:MARSHALL, DENISE RUTH (ATC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:RUTH
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3265 E 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-6487
Mailing Address - Country:US
Mailing Address - Phone:402-276-5241
Mailing Address - Fax:
Practice Address - Street 1:3014 8TH ST APT 3
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-6487
Practice Address - Country:US
Practice Address - Phone:402-276-5241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer