Provider Demographics
NPI:1598963258
Name:MARQUIS, BETHANY CHANDLER (PT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:CHANDLER
Last Name:MARQUIS
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 1:552 E PRESQUE ISLE RD
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-3641
Mailing Address - Country:US
Mailing Address - Phone:207-496-3317
Mailing Address - Fax:
Practice Address - Street 1:10 BERNADETTE ST
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2038
Practice Address - Country:US
Practice Address - Phone:207-498-3102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1153225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist