Healthcare Provider Details

I. General information

NPI: 1396239653
Provider Name (Legal Business Name): RACHEL BLUM MARSHALL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 CORPORATE WOODS DR STE 300
PENSACOLA FL
32504-8974
US

IV. Provider business mailing address

1100 CIRCLE 75 PKWY SE STE 1400
ATLANTA GA
30339-3067
US

V. Phone/Fax

Practice location:
  • Phone: 850-912-6840
  • Fax: 850-912-6843
Mailing address:
  • Phone: 678-981-3543
  • Fax: 404-777-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9251
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: