Provider Demographics
NPI:1184048217
Name:SCARBROUGH, MARCIA
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:SCARBROUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARCIA
Other - Middle Name:LYNN
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:164 ASCOT AVE
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-3502
Mailing Address - Country:US
Mailing Address - Phone:248-682-9651
Mailing Address - Fax:
Practice Address - Street 1:5601 HATCHERY RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-3451
Practice Address - Country:US
Practice Address - Phone:248-674-5367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5002001910225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant