Provider Demographics
NPI:1912553256
Name:ETIENNE, MARIE C (DPT)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:C
Last Name:ETIENNE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:C
Other - Last Name:SANDAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 922
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-0922
Mailing Address - Country:US
Mailing Address - Phone:866-309-5567
Mailing Address - Fax:812-491-1269
Practice Address - Street 1:515 READ ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1739
Practice Address - Country:US
Practice Address - Phone:812-437-1420
Practice Address - Fax:812-437-1425
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013509A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05013509AOtherPHYSICAL THERAPIST LICENSE