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NPI Code Detail

MEDICARE: CHARLES MARSH

MEDICARE: CHARLES MARSH
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
1225100000XPhysical Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101279OTHERMOLICENSE #

General Provider Information

NPI Number : 1598874174
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES MARSH
Provider Business Mailing Address
First Line : 116 ASHLAND PL
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63301-0702
Country : US
Telephone Number : 636-724-5797
Fax Number :
Provider Business Practice Location Address
First Line : 2454 W CLAY ST
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63301-2548
Country : US
Telephone Number : 636-949-2020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2006
Last Update Date : 07/08/2007

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Directions to “ CHARLES MARSH ” Practice Location

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