Provider Demographics
NPI:1295894657
Name:MARSHALL CORLEY, ROSEMARY LEIGH (PT)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:LEIGH
Last Name:MARSHALL CORLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 QUILLIANS DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-2885
Mailing Address - Country:US
Mailing Address - Phone:678-616-3099
Mailing Address - Fax:770-406-6840
Practice Address - Street 1:5226 DAHLONEGA HWY
Practice Address - Street 2:UNIT 3
Practice Address - City:CLERMONT
Practice Address - State:GA
Practice Address - Zip Code:30527-1946
Practice Address - Country:US
Practice Address - Phone:678-616-3099
Practice Address - Fax:770-406-6840
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005935225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000812149HMedicaid
GA000812149DMedicaid