Provider Demographics
NPI:1619727740
Name:MARSHALL, JOHN P (FITNESS TRAINER)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:P
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:FITNESS TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5606 N UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1940
Mailing Address - Country:US
Mailing Address - Phone:719-339-0690
Mailing Address - Fax:
Practice Address - Street 1:5606 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1940
Practice Address - Country:US
Practice Address - Phone:719-339-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO072901917208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation