Provider Demographics
NPI:1295442275
Name:MARX, THEA R (ND)
Entity type:Individual
Prefix:DR
First Name:THEA
Middle Name:R
Last Name:MARX
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-1120
Mailing Address - Country:US
Mailing Address - Phone:307-272-8432
Mailing Address - Fax:
Practice Address - Street 1:1817 BLACK ROCK TPKE STE 205
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-3546
Practice Address - Country:US
Practice Address - Phone:203-717-1339
Practice Address - Fax:203-612-4414
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT716175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath