Provider Demographics
NPI:1841329158
Name:FANNING, MARCIA RENEE (MPT)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:RENEE
Last Name:FANNING
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 LEE ROAD 2118
Mailing Address - Street 2:
Mailing Address - City:SMITHS
Mailing Address - State:AL
Mailing Address - Zip Code:36877-3267
Mailing Address - Country:US
Mailing Address - Phone:334-448-4704
Mailing Address - Fax:
Practice Address - Street 1:300 GUINEVERE CT
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-2501
Practice Address - Country:US
Practice Address - Phone:334-741-0336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist