Provider Demographics
NPI:1508009002
Name:SILVEIRA, MARCO LUIS (PT)
Entity Type:Individual
Prefix:MR
First Name:MARCO
Middle Name:LUIS
Last Name:SILVEIRA
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 1:1489 W LACEY BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5957
Mailing Address - Country:US
Mailing Address - Phone:559-585-8087
Mailing Address - Fax:559-585-1933
Practice Address - Street 1:1489 W LACEY BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5957
Practice Address - Country:US
Practice Address - Phone:559-585-8087
Practice Address - Fax:559-585-1933
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA228432251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic