Basic Information
| Provider Information | |||||||||
| NPI: | 1518217314 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARSHALL | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 W CHESTER PIKE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | HAVERTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190834500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104468410 | ||||||||
| FaxNumber: | 6104468554 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 MACDADE BLVD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | FOLSOM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190333203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105867000 | ||||||||
| FaxNumber: | 6105867004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2012 | ||||||||
| LastUpdateDate: | 09/19/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | PT022296 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.