Provider Demographics
NPI:1063696367
Name:MARSHALL, DENNIS YASUDA (RRT)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:YASUDA
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73-4326 AKA AKA PLACE
Mailing Address - Street 2:
Mailing Address - City:KAILUA-KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-9507
Mailing Address - Country:US
Mailing Address - Phone:808-938-1052
Mailing Address - Fax:
Practice Address - Street 1:5901 BROKEN SOUND PKWY
Practice Address - Street 2:SUITE 500
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2773
Practice Address - Country:US
Practice Address - Phone:561-367-0884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDL04915227900000X
MA5679227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered