Provider Demographics
NPI:1114223385
Name:MAQUILING, IVY (PT)
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:
Last Name:MAQUILING
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 1:1406 THIRD ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-2849
Mailing Address - Country:US
Mailing Address - Phone:707-287-0879
Mailing Address - Fax:
Practice Address - Street 1:3275 VILLA LN
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3016
Practice Address - Country:US
Practice Address - Phone:707-257-0931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2011-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist