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General NPI Number Information
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NPI Number | 1891408282
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Entity Type | Individual
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Provider Name | CAROL STRUCK
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Gender | Female
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Dates
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Enumeration Date | 12/30/2022
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Last Update Date | 12/30/2022
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Provider Practice Location Address
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Address Line | 1901 DIVISION ST
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City | MARQUETTE
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State | MI
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Zip | 49855-5168
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Country | US
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Telephone | 906-225-4488
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Fax |
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Provider Business Mailing Address
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Address Line | 30 HEIDI DR
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City | MARQUETTE
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State | MI
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Zip | 49855-9318
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Country | US
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Telephone | 906-458-0238
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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 | 5501008520
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License Number State | MI
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