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Individual
SHAWN AMANDA MARQUIS
Active
Individual
SHAWN AMANDA MARQUIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6139
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07F36MA
BLUE CROSS INDIVIDUAL ID
MN
01
—
1024610
PREFFERED 1 INDIVIDUAL ID
MN
01
—
6B478OR
BLUE CROSS BLUE SHIELD GR
MN
Enumeration date
01/24/2007
Last updated
10/02/2007
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