Provider Demographics
NPI:1922268630
Name:MARKS, WILLIAN L (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAN
Middle Name:L
Last Name:MARKS
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 1:150 126TH ST
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-5016
Mailing Address - Country:US
Mailing Address - Phone:208-476-7105
Mailing Address - Fax:208-476-7233
Practice Address - Street 1:150 126TH ST
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-5016
Practice Address - Country:US
Practice Address - Phone:208-476-7105
Practice Address - Fax:208-476-7233
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRPT1538225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist