Provider Demographics
NPI:1902206931
Name:MARSHALL, JOHN (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 877
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28017-0877
Mailing Address - Country:US
Mailing Address - Phone:704-406-3583
Mailing Address - Fax:704-406-3595
Practice Address - Street 1:110 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28017-9797
Practice Address - Country:US
Practice Address - Phone:704-406-3583
Practice Address - Fax:704-406-3595
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-24952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer