Provider Demographics
NPI:1053543314
Name:PEARSON, MARCUS ANTWAN (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:ANTWAN
Last Name:PEARSON
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043
Mailing Address - Country:US
Mailing Address - Phone:931-919-3833
Mailing Address - Fax:931-919-3832
Practice Address - Street 1:1832 MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:US
Practice Address - Phone:931-919-3833
Practice Address - Fax:931-919-3832
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8461225100000X
TNPT8461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1515150Medicaid
TN0446631Medicaid