Healthcare Provider Details

I. General information

NPI: 1821382334
Provider Name (Legal Business Name): AMY POLLARD MARSHALL P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69154 HWY 190 SERV RD
COVINGTON LA
70433-5140
US

IV. Provider business mailing address

1090 WHITETAIL DR
MANDEVILLE LA
70448-1996
US

V. Phone/Fax

Practice location:
  • Phone: 985-893-2845
  • Fax: 985-893-2654
Mailing address:
  • Phone: 985-674-1039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA2572
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: