Provider Demographics
NPI:1609057264
Name:MARLIS ENTERPRISES INC.
Entity Type:Organization
Organization Name:MARLIS ENTERPRISES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTE
Authorized Official - Middle Name:B
Authorized Official - Last Name:SCHEUFFELE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-736-0699
Mailing Address - Street 1:PO BOX 1218
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:WA
Mailing Address - Zip Code:98579-1218
Mailing Address - Country:US
Mailing Address - Phone:360-736-0699
Mailing Address - Fax:360-736-0324
Practice Address - Street 1:2605 NE KRESKY AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2411
Practice Address - Country:US
Practice Address - Phone:360-736-0699
Practice Address - Fax:360-736-0324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0175452OtherL&I PIN
G8805485OtherMEDICARE GROUP PIN
0175452OtherL&I PIN