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General NPI Number Information
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NPI Number | 1043429632
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Entity Type | Individual
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Provider Name | MARLENE CAROLE CARTER MARX P.T,
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 808 MAIN ST E
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City | MENOMONIE
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State | WI
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Zip | 54751-2735
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Country | US
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Telephone | 715-231-2771
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Fax |
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Provider Business Mailing Address
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Address Line | E2851 JAMES LN
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City | EAU CLAIRE
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State | WI
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Zip | 54701-8545
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Country | US
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Telephone | 715-878-4678
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2661-024
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 2661-24
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1015
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License Number State | MN
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