Provider Demographics
NPI:1013373422
Name:MARQUEZ, RAIDA M (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:RAIDA
Middle Name:M
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:RHAIDA
Other - Middle Name:
Other - Last Name:MIRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:306 W SOMERDALE RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2237
Mailing Address - Country:US
Mailing Address - Phone:856-504-3150
Mailing Address - Fax:856-504-3157
Practice Address - Street 1:306 W SOMERDALE RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2237
Practice Address - Country:US
Practice Address - Phone:856-504-3150
Practice Address - Fax:856-504-3157
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00929800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist