Provider Demographics
NPI:1265629927
Name:VIVES VASQUEZ, CECILIA LIZ (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:CECILIA
Middle Name:LIZ
Last Name:VIVES VASQUEZ
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:535 WOODBRIDGE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49090
Mailing Address - Country:US
Mailing Address - Phone:269-639-8915
Mailing Address - Fax:269-639-8911
Practice Address - Street 1:23701 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:MATTAWAN
Practice Address - State:MI
Practice Address - Zip Code:49090
Practice Address - Country:US
Practice Address - Phone:269-668-7770
Practice Address - Fax:269-668-7770
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501008788225100000X
IN05004642A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist