Provider Demographics
NPI:1154445617
Name:MARIQUIT, ERNESTO (RPT)
Entity Type:Individual
Prefix:MR
First Name:ERNESTO
Middle Name:
Last Name:MARIQUIT
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 COUNTRY SIDE DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2069
Mailing Address - Country:US
Mailing Address - Phone:321-229-4168
Mailing Address - Fax:407-814-3153
Practice Address - Street 1:2107 COUNTRY SIDE DR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-2069
Practice Address - Country:US
Practice Address - Phone:321-229-4168
Practice Address - Fax:407-814-3153
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL5636225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY2854Medicare ID - Type UnspecifiedPHYSICAL THERAPY