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General NPI Number Information
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NPI Number | 1104702711
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Entity Type | Individual
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Provider Name | JOAQUIN IVAN PASQUEL SALCEDO PT
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Gender | Male
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 2133 S STATE ROUTE 157
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-3607
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Country | US
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Telephone | 618-650-8337
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Fax |
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Provider Business Mailing Address
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Address Line | 3016 HH RD
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City | WATERLOO
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State | IL
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Zip | 62298-5204
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Country | US
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Telephone | 602-754-9156
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.029269
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2025050001
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License Number State | MO
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