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NPI Code Detail

MEDICARE: MR. COREY MARQUIS PTA

MEDICARE: MR. COREY MARQUIS PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant1537AR

General Provider Information

NPI Number : 1366402109
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. COREY MARQUIS PTA
Provider Business Mailing Address
First Line : 3609 S BRANCH HOLLOW RD
Second Line :
City : VAN BUREN
State : AR
Zip : 72956-6702
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3304 S M ST
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-2903
Country : US
Telephone Number : 479-785-4677
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2006
Last Update Date : 07/08/2007

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