Provider Demographics
NPI:1700416104
Name:COURCHESNE, MARILYN MARQUERITE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:MARQUERITE
Last Name:COURCHESNE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:MS
Other - First Name:MARILYN
Other - Middle Name:MARQUERITE
Other - Last Name:COURCHESNE
Other - Suffix:X
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 E ASHBY PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-5835
Mailing Address - Country:US
Mailing Address - Phone:210-291-9912
Mailing Address - Fax:
Practice Address - Street 1:105 E ASHBY PL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5835
Practice Address - Country:US
Practice Address - Phone:210-291-9912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT005799225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty