Healthcare Provider Details

I. General information

NPI: 1992847081
Provider Name (Legal Business Name): MARSHALL MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 MARSHALL WAY SUITE C
PLACERVILLE CA
95667-5706
US

IV. Provider business mailing address

1100 MARSHALL WAY
PLACERVILLE CA
95667-6533
US

V. Phone/Fax

Practice location:
  • Phone: 530-344-5430
  • Fax:
Mailing address:
  • Phone: 530-344-5430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: LAURIE ELDRIDGE
Title or Position: CFO
Credential:
Phone: 530-626-2780