Provider Demographics
NPI:1730129040
Name:MARSHALL, RICHARD DEAN (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DEAN
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:1441 DEETZ RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-9150
Mailing Address - Country:US
Mailing Address - Phone:530-926-4534
Mailing Address - Fax:530-926-1248
Practice Address - Street 1:1208 EVERITT MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-9758
Practice Address - Country:US
Practice Address - Phone:530-926-1290
Practice Address - Fax:530-926-1248
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist