Provider Demographics
NPI:1659639615
Name:MARQUEZ, ANNE M (MED, ATC/L)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:MED, ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C113 JOYCE CENTER
Mailing Address - Street 2:
Mailing Address - City:NOTRE DAME
Mailing Address - State:IN
Mailing Address - Zip Code:46556
Mailing Address - Country:US
Mailing Address - Phone:574-631-7100
Mailing Address - Fax:574-631-3207
Practice Address - Street 1:C113 JOYCE CENTER
Practice Address - Street 2:
Practice Address - City:NOTRE DAME
Practice Address - State:IN
Practice Address - Zip Code:46556
Practice Address - Country:US
Practice Address - Phone:574-631-7100
Practice Address - Fax:574-631-3207
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001403A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer