Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 1015 | MN |
N | 225100000X | Physical Therapist | 2661-024 | WI |
Y | 2251P0200X | Physical Therapist - Pediatrics | 2661-24 | WI |
NPI | 1043429632 |
---|---|
Provider Name | Ms. Marlene Carole Carter Marx |
First Address | Eau Claire, WI 54701-8545 |
Second Address | Menomonie, WI 54751-2735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 20/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40143300 | (05) | WI |