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General NPI Number Information
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NPI Number | 1639988843
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Entity Type | Individual
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Provider Name | MARISSA GRACE ARCHER PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 1781 AZ-69 #27
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City | PRESCOTT
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State | AZ
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Zip | 86301
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Country | US
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Telephone | 928-515-3118
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Fax |
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Provider Business Mailing Address
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Address Line | 4441 N LODGEPOLE CT
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-7690
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Country | US
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Telephone | 928-308-0492
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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 | LPT-033971
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License Number State | AZ
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