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General NPI Number Information
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NPI Number | 1578388542
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Entity Type | Individual
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Provider Name | DYLAN MARSHALL
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Gender | Male
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 2140 WARRENSVILLE RD
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City | MONTOURSVILLE
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State | PA
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Zip | 17754-9621
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Country | US
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Telephone | 570-433-3161
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Fax |
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Provider Business Mailing Address
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Address Line | 115 RIVE MILL ROAD EXT
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City | JERSEY SHORE
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State | PA
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Zip | 17740
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Country | US
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Telephone |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | TE013683
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License Number State | PA
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