Provider Demographics
NPI:1083861322
Name:BAQUERIZO, JULIETA M (PT)
Entity Type:Individual
Prefix:MS
First Name:JULIETA
Middle Name:M
Last Name:BAQUERIZO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 NE 7TH ST APT BB7
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-4983
Mailing Address - Country:US
Mailing Address - Phone:360-281-7796
Mailing Address - Fax:
Practice Address - Street 1:11301 NE 7TH ST APT BB7
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-4983
Practice Address - Country:US
Practice Address - Phone:360-281-7796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist