Healthcare Provider Details

I. General information

NPI: 1184691735
Provider Name (Legal Business Name): XAVIER MARQUEZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 WATERHOUSE RD STE 204
BOURNE MA
02532-3890
US

IV. Provider business mailing address

703 GRANITE ST STE 3
BRAINTREE MA
02184-5350
US

V. Phone/Fax

Practice location:
  • Phone: 781-961-3370
  • Fax:
Mailing address:
  • Phone: 781-961-3370
  • Fax: 505-830-6505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number26980
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3152
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: