Provider Demographics
NPI:1649849068
Name:MARSHALL, DEMERISE DANIELLE (DPT)
Entity type:Individual
Prefix:MS
First Name:DEMERISE
Middle Name:DANIELLE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 HORIZON VIEW DR
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-2415
Mailing Address - Country:US
Mailing Address - Phone:518-610-1363
Mailing Address - Fax:
Practice Address - Street 1:2880 US HIGHWAY 9 STE 1
Practice Address - Street 2:
Practice Address - City:VALATIE
Practice Address - State:NY
Practice Address - Zip Code:12184-5423
Practice Address - Country:US
Practice Address - Phone:518-758-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist