Provider Demographics
NPI:1588675748
Name:MARSH, DANEEN M (PT)
Entity Type:Individual
Prefix:MRS
First Name:DANEEN
Middle Name:M
Last Name:MARSH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6248 RIDERS RD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-5146
Mailing Address - Country:US
Mailing Address - Phone:432-366-9541
Mailing Address - Fax:432-366-1951
Practice Address - Street 1:4407 N GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-5311
Practice Address - Country:US
Practice Address - Phone:432-366-9541
Practice Address - Fax:432-366-1951
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1058147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B2470Medicare ID - Type Unspecified