Provider Demographics
NPI:1407891344
Name:LAQUI, GERVACIO MARASIGAN (MHSCPT,MTC,MGS)
Entity Type:Individual
Prefix:
First Name:GERVACIO
Middle Name:MARASIGAN
Last Name:LAQUI
Suffix:
Gender:M
Credentials:MHSCPT,MTC,MGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2037 DEVEERE DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5853
Mailing Address - Country:US
Mailing Address - Phone:586-883-4176
Mailing Address - Fax:586-983-2501
Practice Address - Street 1:37300 DEQUINDRE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3591
Practice Address - Country:US
Practice Address - Phone:586-983-2498
Practice Address - Fax:586-983-2501
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010077992251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic