Provider Demographics
NPI:1407533391
Name:MARQUEZ, MYRIAM (PTA)
Entity Type:Individual
Prefix:
First Name:MYRIAM
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 CLARKSTONE CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-1191
Mailing Address - Country:US
Mailing Address - Phone:915-843-6648
Mailing Address - Fax:
Practice Address - Street 1:6351 S DESERT BLVD BLDG C
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-1219
Practice Address - Country:US
Practice Address - Phone:915-261-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant