=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326178732
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIE LOUISE MERKX-QUINN PT, OCS, CERT MDT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2007
-----------------------------------------------------
Last Update Date | 02/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2020 RAYBROOK ST SE SUITE #304
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49546-7717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-464-3580
-----------------------------------------------------
Fax | 616-464-3581
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2020 RAYBROOK ST SE SUITE #304
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49546-7717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-464-3580
-----------------------------------------------------
Fax | 616-464-3581
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | L736622
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------