Provider Demographics
NPI:1215058391
Name:MARRIOTT, DAVID A JR (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:MARRIOTT
Suffix:JR
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 1:450 HAWKRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7652
Mailing Address - Country:US
Mailing Address - Phone:443-603-6362
Mailing Address - Fax:
Practice Address - Street 1:450 HAWKRIDGE LN
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-7652
Practice Address - Country:US
Practice Address - Phone:443-603-6362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20769225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
61777101OtherMD-COMMERCIAL NUMBER