Provider Demographics
NPI:1780196436
Name:PIONK, MARCI AMELIA (AT, ATC)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:AMELIA
Last Name:PIONK
Suffix:
Gender:F
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-3917
Mailing Address - Country:US
Mailing Address - Phone:989-476-0032
Mailing Address - Fax:
Practice Address - Street 1:250 E TUTTLE RD
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-8605
Practice Address - Country:US
Practice Address - Phone:616-902-4182
Practice Address - Fax:616-775-5959
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010008752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer