Provider Demographics
NPI:1396949806
Name:JACQUINOT, MARLA J (PT)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:J
Last Name:JACQUINOT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:J
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:601 E 63RD ST STE 230
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-3303
Mailing Address - Country:US
Mailing Address - Phone:816-569-2802
Mailing Address - Fax:
Practice Address - Street 1:601 E 63RD ST STE 230
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-3303
Practice Address - Country:US
Practice Address - Phone:816-569-2802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03521225100000X
MO2000167616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KST66000002OtherMEDICARE PTAN
MOT66A00003OtherMEDICARE PTAN