Provider Demographics
NPI:1225301914
Name:CALDERON, LUISITO J (PT)
Entity Type:Individual
Prefix:MR
First Name:LUISITO
Middle Name:J
Last Name:CALDERON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 MORNING MIST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-8187
Mailing Address - Country:US
Mailing Address - Phone:231-668-2886
Mailing Address - Fax:
Practice Address - Street 1:1810 MORNING MIST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-8187
Practice Address - Country:US
Practice Address - Phone:231-668-2886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-11
Last Update Date:2012-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist