Provider Demographics
NPI:1740654706
Name:MARQUETTE, SEAN
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:MARQUETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30800 TELEGRAPH RD
Mailing Address - Street 2:STE 1728
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4542
Mailing Address - Country:US
Mailing Address - Phone:248-967-8741
Mailing Address - Fax:
Practice Address - Street 1:30800 TELEGRAPH RD
Practice Address - Street 2:STE 1728
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4542
Practice Address - Country:US
Practice Address - Phone:248-967-8741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist