Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT293804 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT293804 | CA |
NPI | 1013409499 |
---|---|
Provider Name | Matthew Lyndon Marshall |
First Address | Travis Afb, CA 94535-1809 |
Second Address | Fairfield, CA 94535-1809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2018 |
Last Update Date | 16/12/2021 |