Healthcare Provider Details

I. General information

NPI: 1740103209
Provider Name (Legal Business Name): DEIRDRE MARSHALL AAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3899 W FRONT ST
TRAVERSE CITY MI
49684-8103
US

IV. Provider business mailing address

2284 JEFFERSON RD
PENTWATER MI
49449-9462
US

V. Phone/Fax

Practice location:
  • Phone: 231-944-6541
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502009056
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: