Provider Demographics
NPI:1063633766
Name:MARSH, ANDREW BAKER (PT)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:BAKER
Last Name:MARSH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 MOOREVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MI
Mailing Address - Zip Code:48160-9569
Mailing Address - Country:US
Mailing Address - Phone:734-763-4767
Mailing Address - Fax:734-763-3715
Practice Address - Street 1:325 E EISENHOWER PKWY
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3364
Practice Address - Country:US
Practice Address - Phone:734-763-4767
Practice Address - Fax:734-763-3715
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009623261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy