Provider Demographics
NPI:1538378435
Name:MARSHALL, NATHANIAL JOSEPH (LMP)
Entity type:Individual
Prefix:
First Name:NATHANIAL
Middle Name:JOSEPH
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 NEVADA ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-5722
Mailing Address - Country:US
Mailing Address - Phone:360-319-1469
Mailing Address - Fax:
Practice Address - Street 1:904 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5223
Practice Address - Country:US
Practice Address - Phone:360-650-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023309225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist