Provider Demographics
NPI:1396299186
Name:MARLIN GARCIA, ADELICIA (PT)
Entity type:Individual
Prefix:
First Name:ADELICIA
Middle Name:
Last Name:MARLIN GARCIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ADELICIA
Other - Middle Name:
Other - Last Name:MARLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:625 KENMOOR AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2395
Mailing Address - Country:US
Mailing Address - Phone:616-356-5000
Mailing Address - Fax:616-356-5001
Practice Address - Street 1:12849 N US HIGHWAY 131 STE 1
Practice Address - Street 2:
Practice Address - City:SCHOOLCRAFT
Practice Address - State:MI
Practice Address - Zip Code:49087-8901
Practice Address - Country:US
Practice Address - Phone:616-356-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1278629225100000X
MI5501018744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist