Provider Demographics
NPI:1013075001
Name:MARSHALL, MARCI LYNN (PT)
Entity type:Individual
Prefix:
First Name:MARCI
Middle Name:LYNN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6091 TOURSOME DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-8015
Mailing Address - Country:US
Mailing Address - Phone:240-449-9870
Mailing Address - Fax:301-829-3211
Practice Address - Street 1:6091 TOURSOME DR
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-8015
Practice Address - Country:US
Practice Address - Phone:240-449-9870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15874225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD252P530GMedicare ID - Type UnspecifiedID NUMBER