Provider Demographics
NPI:1962782839
Name:MARSHALL, ERIC R (PT, DPT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:R
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 LACONIA RD
Mailing Address - Street 2:UNIT 2
Mailing Address - City:TILTON
Mailing Address - State:NH
Mailing Address - Zip Code:03276-5322
Mailing Address - Country:US
Mailing Address - Phone:603-717-7010
Mailing Address - Fax:
Practice Address - Street 1:614 LACONIA RD
Practice Address - Street 2:UNIT 2
Practice Address - City:TILTON
Practice Address - State:NH
Practice Address - Zip Code:03276-5322
Practice Address - Country:US
Practice Address - Phone:603-717-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist