Provider Demographics
NPI:1629329941
Name:MARQUIS, MICHELLE ELIZABETH (DPT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:MARQUIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 N STATE ROUTE 121
Mailing Address - Street 2:
Mailing Address - City:MT ZION
Mailing Address - State:IL
Mailing Address - Zip Code:62549-1219
Mailing Address - Country:US
Mailing Address - Phone:217-864-0820
Mailing Address - Fax:
Practice Address - Street 1:1045 N STATE ROUTE 121
Practice Address - Street 2:
Practice Address - City:MT ZION
Practice Address - State:IL
Practice Address - Zip Code:62549-1219
Practice Address - Country:US
Practice Address - Phone:217-864-0820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070019501225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070019501Medicaid