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General NPI Number Information
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NPI Number | 1154445617
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Entity Type | Individual
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Provider Name | ERNESTO MARIQUIT RPT
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Gender | Male
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 2107 COUNTRY SIDE DR
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City | APOPKA
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State | FL
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Zip | 32712-2069
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Country | US
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Telephone | 321-229-4168
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Fax | 407-814-3153
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Provider Business Mailing Address
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Address Line | 2107 COUNTRY SIDE DR
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City | APOPKA
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State | FL
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Zip | 32712-2069
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Country | US
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Telephone | 321-229-4168
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Fax | 407-814-3153
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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 | FL5636
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License Number State | FL
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