Provider Demographics
NPI:1003383035
Name:POQUIZ, SOLEDAD (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:SOLEDAD
Middle Name:
Last Name:POQUIZ
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 PURDY DR
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-2160
Mailing Address - Country:US
Mailing Address - Phone:989-331-4022
Mailing Address - Fax:
Practice Address - Street 1:1011 OLD U.S. 27 SUITE A
Practice Address - Street 2:
Practice Address - City:ST. JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879
Practice Address - Country:US
Practice Address - Phone:989-224-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1588642110225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty