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General NPI Number Information
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NPI Number | 1114791548
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Entity Type | Individual
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Provider Name | JACKIE SUE MARCOTTE DPT, CLT-LANA
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Gender | Female
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Dates
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Enumeration Date | 11/07/2023
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 1350 ST PETER AVENUE E
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City | DELANO
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State | MN
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Zip | 55328
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Country | US
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Telephone | 763-452-9292
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Fax |
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Provider Business Mailing Address
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Address Line | 6196 KALENDA LN NE
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City | ALBERTVILLE
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State | MN
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Zip | 55301-9652
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Country | US
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Telephone | 612-418-6031
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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 | 10969
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License Number State | MN
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