Provider Demographics
NPI:1023128030
Name:MARQUETTE, GERALD JAY (RPT)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:JAY
Last Name:MARQUETTE
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13420 BRIAR DR STE C
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3411
Mailing Address - Country:US
Mailing Address - Phone:913-484-7632
Mailing Address - Fax:913-808-5460
Practice Address - Street 1:13420 BRIAR DR STE C
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209
Practice Address - Country:US
Practice Address - Phone:913-484-7632
Practice Address - Fax:913-808-5460
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02826225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000140918OtherBLUE CROSS BLUE SHIELD
KS11549331OtherCAQH