Provider Demographics
NPI:1851350193
Name:MARQUARDT, JASON ANTHONY (PT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ANTHONY
Last Name:MARQUARDT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 NORTH PINE CIR
Mailing Address - Street 2:
Mailing Address - City:BALLEAIR
Mailing Address - State:FL
Mailing Address - Zip Code:33765
Mailing Address - Country:US
Mailing Address - Phone:727-458-3305
Mailing Address - Fax:727-518-7897
Practice Address - Street 1:301 W BAY DR
Practice Address - Street 2:STE 7
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770
Practice Address - Country:US
Practice Address - Phone:727-518-7346
Practice Address - Fax:727-518-7897
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT016943225100000X
TXPT1141703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist