Provider Demographics
NPI:1659391498
Name:PRIOR, MARILYN K (PT)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:K
Last Name:PRIOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24519 REDLANDS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4016
Mailing Address - Country:US
Mailing Address - Phone:909-799-0078
Mailing Address - Fax:909-799-8464
Practice Address - Street 1:24519 REDLANDS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-4016
Practice Address - Country:US
Practice Address - Phone:909-799-0078
Practice Address - Fax:909-799-8464
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10716225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT10716OtherSTATE LICENSE