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NPI Code Detail

MEDICARE: MR. SEAN MICHAEL MARSHALL MPT

MEDICARE: MR. SEAN MICHAEL MARSHALL 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 Therapist5501011678MI

General Provider Information

NPI Number : 1679589733
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SEAN MICHAEL MARSHALL MPT
Provider Business Mailing Address
First Line : 25990 CROCKER BLVD
Second Line :
City : HARRISON TOWNSHIP
State : MI
Zip : 48045-3450
Country : US
Telephone Number : 586-466-5302
Fax Number : 586-466-5397
Provider Business Practice Location Address
First Line : 25990 CROCKER BLVD
Second Line :
City : HARRISON TOWNSHIP
State : MI
Zip : 48045-3450
Country : US
Telephone Number : 586-466-5302
Fax Number : 586-466-5397
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 02/17/2018

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