Provider Demographics
NPI:1194880039
Name:MARSHALL, ANNETTE M (PT)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:M
Last Name:MARSHALL
Suffix:
Gender:F
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:PO BOX 2065
Mailing Address - Street 2:
Mailing Address - City:AMAGANSETT
Mailing Address - State:NY
Mailing Address - Zip Code:11930-2065
Mailing Address - Country:US
Mailing Address - Phone:631-267-3755
Mailing Address - Fax:631-267-3755
Practice Address - Street 1:518 MONTAUK HWY
Practice Address - Street 2:SUITE 106
Practice Address - City:AMAGANSETT
Practice Address - State:NY
Practice Address - Zip Code:11930
Practice Address - Country:US
Practice Address - Phone:631-267-3755
Practice Address - Fax:631-267-3755
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013019-1225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY013019-1OtherN Y STATE
NY013019-1OtherN Y STATE