Provider Demographics
NPI:1134447014
Name:MARSH, EVAN JOSEPH (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:EVAN
Middle Name:JOSEPH
Last Name:MARSH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
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Mailing Address - Street 1:7 HEMPHILL PLACE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4482
Mailing Address - Country:US
Mailing Address - Phone:518-289-5242
Mailing Address - Fax:518-289-5294
Practice Address - Street 1:7 HEMPHILL PLACE
Practice Address - Street 2:SUITE 130
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-4482
Practice Address - Country:US
Practice Address - Phone:518-289-5242
Practice Address - Fax:518-289-5294
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2017-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY032590208100000X
NY032590-1225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic