Provider Demographics
NPI:1043688781
Name:MARQUART, KELLY (MSPT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MARQUART
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6400 JEFFERSON ST NE
Mailing Address - Street 2:#102
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3470
Mailing Address - Country:US
Mailing Address - Phone:505-344-2922
Mailing Address - Fax:505-214-5030
Practice Address - Street 1:6400 JEFFERSON ST NE
Practice Address - Street 2:#102
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3470
Practice Address - Country:US
Practice Address - Phone:505-344-2922
Practice Address - Fax:505-214-5030
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM3097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist