Provider Demographics
NPI:1538499306
Name:WASHINGTON, MARCUS (ATC)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60208-0844
Mailing Address - Country:US
Mailing Address - Phone:847-467-3538
Mailing Address - Fax:847-491-2120
Practice Address - Street 1:633 EMERSON ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60208-0844
Practice Address - Country:US
Practice Address - Phone:847-467-3538
Practice Address - Fax:847-491-2120
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0026422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer