Provider Demographics
NPI:1275691032
Name:MARQUEZ, ROBIN T (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBIN
Middle Name:T
Last Name:MARQUEZ
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:PO BOX 2188
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49016-2188
Mailing Address - Country:US
Mailing Address - Phone:269-288-0257
Mailing Address - Fax:269-962-0439
Practice Address - Street 1:229 NORTH AVENUE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017
Practice Address - Country:US
Practice Address - Phone:269-288-0257
Practice Address - Fax:269-962-0439
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0007197770OtherAETNA
MI113892OtherPPOM
MI113892OtherPPOM
MIN90030001Medicare ID - Type UnspecifiedMEDICARE