Provider Demographics
NPI:1821382334
Name:MARSHALL, AMY POLLARD (PTA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:POLLARD
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 WHITETAIL DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-1996
Mailing Address - Country:US
Mailing Address - Phone:985-674-1039
Mailing Address - Fax:
Practice Address - Street 1:69154 HWY 190 SERV RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5140
Practice Address - Country:US
Practice Address - Phone:985-893-2845
Practice Address - Fax:985-893-2654
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA2572225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant