Healthcare Provider Details

I. General information

NPI: 1497939573
Provider Name (Legal Business Name): DAVID RODNEY MARSHALL CPED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 STATE ROAD 13 SUITE 100
FRUIT COVE FL
32259-3175
US

IV. Provider business mailing address

585 STATE ROAD 13 NORTH #100
FRUIT COVE FL
32259-3175
US

V. Phone/Fax

Practice location:
  • Phone: 904-230-8229
  • Fax: 904-230-8219
Mailing address:
  • Phone: 904-230-8229
  • Fax: 904-230-8219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPED151
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: