Provider Demographics
NPI:1013111079
Name:MARSH, STEPHEN NEIL (PTA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:NEIL
Last Name:MARSH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7126 FM 934
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76670-1140
Mailing Address - Country:US
Mailing Address - Phone:254-632-4097
Mailing Address - Fax:
Practice Address - Street 1:3300 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2412
Practice Address - Country:US
Practice Address - Phone:903-641-0626
Practice Address - Fax:903-641-0626
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2028926225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant