Individual
SHANE D MARQUARDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15418 MAIN ST, MILL CREEK, WA 98012-9030
(425) 742-6034
Mailing address
15418 MAIN ST UNIT M106, MILL CREEK, WA 98012-9021
(425) 742-6034
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
60680370
WA
Other
Enumeration date
07/07/2023
Last updated
07/07/2023
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