Healthcare Provider Details

I. General information

NPI: 1144212416
Provider Name (Legal Business Name): TROY B MARSH PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 N MAIN ST
TOOELE UT
84074-1699
US

IV. Provider business mailing address

PO BOX 307
BOUNTIFUL UT
84011-0307
US

V. Phone/Fax

Practice location:
  • Phone: 435-843-1311
  • Fax: 435-843-9486
Mailing address:
  • Phone: 801-294-6907
  • Fax: 801-294-6917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number122084-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: