Provider Demographics
NPI:1902004054
Name:GASNER, MARLON (PT)
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:
Last Name:GASNER
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 1:700 PRAIRIE LN
Mailing Address - Street 2:
Mailing Address - City:STORM LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50588-7527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 SALE BARN RD
Practice Address - Street 2:3
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-7341
Practice Address - Country:US
Practice Address - Phone:712-213-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03586225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist