Healthcare Provider Details

I. General information

NPI: 1205525326
Provider Name (Legal Business Name): MARSHAL MERCADO PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 SUMMIT BRIDGE RD STE 6
MIDDLETOWN DE
19709-4806
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 302-342-8451
  • Fax:
Mailing address:
  • Phone: 423-702-4389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0014714
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02174700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: