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NPI Code Detail

MEDICARE: MARC GROW MPT

MEDICARE: MARC GROW MPT
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
1225100000XPhysical Therapist1463NV

General Provider Information

NPI Number : 1497939938
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARC GROW MPT
Provider Business Mailing Address
First Line : PO BOX 171
Second Line : SUITE B
City : PARMA
State : ID
Zip : 83660-0171
Country : US
Telephone Number : 208-722-7350
Fax Number : 208-722-7351
Provider Business Practice Location Address
First Line : 2213 NORTH 5TH ST
Second Line : SUITE B
City : ELKO
State : NV
Zip : 89801-2458
Country : US
Telephone Number : 775-777-0901
Fax Number : 775-777-0923
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2007
Last Update Date : 08/11/2016

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Directions to “ MARC GROW MPT” Practice Location

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