Provider Demographics
NPI:1861001083
Name:TAYLOR, MARINA CHEUNG (DPT)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:CHEUNG
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 SCHWALEN CT
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-8319
Mailing Address - Country:US
Mailing Address - Phone:914-843-6026
Mailing Address - Fax:
Practice Address - Street 1:990 MAIN STREET
Practice Address - Street 2:SUITE #1
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002
Practice Address - Country:US
Practice Address - Phone:914-843-6026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9900225100000X
WI14525-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI14525-24OtherSTATE PHYSICAL THERAPY LICENSE