Healthcare Provider Details

I. General information

NPI: 1659578565
Provider Name (Legal Business Name): MARICHU MANATAD SIEGUE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41685 N. OETTING TRAIL,
QUEEN CREEK AZ
85242-4298
US

IV. Provider business mailing address

41685 N. OETTING TRAIL
QUEEN CREEK AZ
85242-4298
US

V. Phone/Fax

Practice location:
  • Phone: 480-983-6747
  • Fax:
Mailing address:
  • Phone: 480-983-6747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5961
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: