MEDICARE: MARILOU FEQUIERE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1237961	TX
2	225100000X	Physical Therapist	25402	FL

General Provider Information

NPI Number	:	1801226618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILOU FEQUIERE

Provider Business Mailing Address
First Line	:	1110 NW 128TH TER
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33168-6533
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 NW 128TH TER
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33168-6533
Country	:	US
Telephone Number	:	305-799-0562
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2013
Last Update Date	:	11/14/2013

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Directions to “ MARILOU FEQUIERE ” Practice Location

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