Provider Demographics
NPI:1538540414
Name:GILL, MARSHA (OMT COM)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:OMT COM
Other - Prefix:MS
Other - First Name:MARCI
Other - Middle Name:MARY
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OMT COM
Mailing Address - Street 1:8447 W DESERT ELM LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-3645
Mailing Address - Country:US
Mailing Address - Phone:602-796-6070
Mailing Address - Fax:888-796-9570
Practice Address - Street 1:14050 N 83RD AVE
Practice Address - Street 2:SUITE 290
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5638
Practice Address - Country:US
Practice Address - Phone:602-796-6070
Practice Address - Fax:888-796-9570
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ554125J00000X, 125Q00000X, 174400000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No125J00000XDental ProvidersDental Therapist
No125Q00000XDental ProvidersDentistOral Medicine
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist