Provider Demographics
NPI:1942592688
Name:SQUIRES, MARILEE ANNE (DPT)
Entity Type:Individual
Prefix:
First Name:MARILEE
Middle Name:ANNE
Last Name:SQUIRES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5313
Mailing Address - Country:US
Mailing Address - Phone:831-375-1885
Mailing Address - Fax:831-375-7436
Practice Address - Street 1:350 BOLLINGER CANYON LN STE A
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-4592
Practice Address - Country:US
Practice Address - Phone:925-735-6414
Practice Address - Fax:925-735-6450
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 37796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFD268ZMedicare PIN