Provider Demographics
NPI:1528476983
Name:MAREK, JOHN MICHAEL (LAT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:MAREK
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:TX
Mailing Address - Zip Code:76520-2751
Mailing Address - Country:US
Mailing Address - Phone:254-697-3902
Mailing Address - Fax:
Practice Address - Street 1:304 E 12TH ST
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:TX
Practice Address - Zip Code:76520-2751
Practice Address - Country:US
Practice Address - Phone:254-697-3902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT42642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer