Provider Demographics
NPI:1679589733
Name:MARSHALL, SEAN MICHAEL (MPT)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:MICHAEL
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25990 CROCKER BLVD
Mailing Address - Street 2:
Mailing Address - City:HARRISON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-3450
Mailing Address - Country:US
Mailing Address - Phone:586-466-5302
Mailing Address - Fax:586-466-5397
Practice Address - Street 1:25990 CROCKER BLVD
Practice Address - Street 2:
Practice Address - City:HARRISON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48045-3450
Practice Address - Country:US
Practice Address - Phone:586-466-5302
Practice Address - Fax:586-466-5397
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist