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Individual

LORI LYNN MARQUARDT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
415 QUAY ST, PORT HURON, MI 48060-3829
(810) 966-3480
Mailing address
415 QUAY ST, PORT HURON, MI 48060-3829

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502001558
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1871542100
MI
Enumeration date
02/25/2019
Last updated
02/25/2019
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