Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2421 | WV |
N | 2251G0304X | Physical Therapist - Geriatrics | 6467 | OH |
NPI | 1326109323 |
---|---|
Provider Name | Mr. Michael Joseph Marks |
First Address | Marietta, OH 45750-8504 |
Second Address | Parkersburg, WV 26101-5340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 19/10/2012 |