Provider Demographics
NPI:1649325002
Name:MARQUIS, SHAWN AMANDA (MSPT)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:AMANDA
Last Name:MARQUIS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:MURPHY
Other - Last Name:MARQUIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSPT
Mailing Address - Street 1:15000 MINNETONKA BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-1506
Mailing Address - Country:US
Mailing Address - Phone:952-935-4037
Mailing Address - Fax:
Practice Address - Street 1:15000 MINNETONKA BLVD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-1506
Practice Address - Country:US
Practice Address - Phone:952-935-4037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6139225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN07F36MAOtherBLUE CROSS INDIVIDUAL ID
MN1024610OtherPREFFERED 1 INDIVIDUAL ID
MN6B478OROtherBLUE CROSS BLUE SHIELD GR
MN650000470Medicare UPIN