Provider Demographics
NPI:1588020176
Name:MARSH, JELEEKA A (PT)
Entity Type:Individual
Prefix:
First Name:JELEEKA
Middle Name:A
Last Name:MARSH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9614 CANNOCK CHASE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-4421
Mailing Address - Country:US
Mailing Address - Phone:832-723-7838
Mailing Address - Fax:
Practice Address - Street 1:9614 CANNOCK CHASE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4421
Practice Address - Country:US
Practice Address - Phone:832-723-7838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21701225100000X
TX1237846225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist