Provider Demographics
NPI:1477964377
Name:ZACHMANN, MARLEY C (DPT)
Entity Type:Individual
Prefix:
First Name:MARLEY
Middle Name:C
Last Name:ZACHMANN
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 1:4204 BOULDER RIDGE ROAD, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-6162
Mailing Address - Country:US
Mailing Address - Phone:701-751-3064
Mailing Address - Fax:701-751-2265
Practice Address - Street 1:4204 BOULDER RIDGE ROAD, SUITE 100
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503
Practice Address - Country:US
Practice Address - Phone:701-751-3064
Practice Address - Fax:701-751-2265
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND425-112255A2300X
ND1749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer