Provider Demographics
NPI:1891030532
Name:MARSHALL, ERIC GLENN II
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:GLENN
Last Name:MARSHALL
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 CORPORATE LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434
Mailing Address - Country:US
Mailing Address - Phone:757-923-3207
Mailing Address - Fax:757-923-3208
Practice Address - Street 1:3005 CORPORATE LN
Practice Address - Street 2:SUITE 200
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434
Practice Address - Country:US
Practice Address - Phone:757-923-3207
Practice Address - Fax:757-923-3208
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist