Provider Demographics
NPI:1518384247
Name:MARSHALL, HEATHER
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1842 THIBODO RD
Mailing Address - Street 2:204
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-7573
Mailing Address - Country:US
Mailing Address - Phone:760-710-9144
Mailing Address - Fax:
Practice Address - Street 1:1842 THIBODO RD
Practice Address - Street 2:204
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-7573
Practice Address - Country:US
Practice Address - Phone:760-710-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist