Provider Demographics
NPI:1891906376
Name:MARSHALL, JOHN HARVEY (NCTMB-MT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:HARVEY
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:NCTMB-MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17030 E CALLE DEL ORO APT C
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-2459
Mailing Address - Country:US
Mailing Address - Phone:480-816-8506
Mailing Address - Fax:
Practice Address - Street 1:17030 E CALLE DEL ORO APT C
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-2459
Practice Address - Country:US
Practice Address - Phone:480-816-8506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-03628172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist