Provider Demographics
NPI:1598810434
Name:MARLATT, RICHARD (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MARLATT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:RICH
Other - Middle Name:
Other - Last Name:MARLATT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:655 E 11TH AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3621
Mailing Address - Country:US
Mailing Address - Phone:541-683-3375
Mailing Address - Fax:
Practice Address - Street 1:655 E 11TH AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3621
Practice Address - Country:US
Practice Address - Phone:541-683-3375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist