MEDICARE: ERIC DANIEL MARQUARDT P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	5501015603	MI

General Provider Information

NPI Number	:	1043505134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC DANIEL MARQUARDT P.T.

Provider Business Mailing Address
First Line	:	3826 44TH ST SE
Second Line	:
City	:	KENTWOOD
State	:	MI
Zip	:	49512-3919
Country	:	US
Telephone Number	:	616-554-0918
Fax Number	:	616-554-3079

Provider Business Practice Location Address
First Line	:	5581 KATHERINE CT
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48603-3624
Country	:	US
Telephone Number	:	989-827-9218
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	07/08/2022

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