Provider Demographics
NPI:1508095985
Name:MARQUEZ, MAY ROSE DELLUZA (PT)
Entity Type:Individual
Prefix:MISS
First Name:MAY ROSE
Middle Name:DELLUZA
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 OLD SPRINGVILLE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-5860
Mailing Address - Country:US
Mailing Address - Phone:205-520-9600
Mailing Address - Fax:
Practice Address - Street 1:1599 KEOKUK ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:IL
Practice Address - Zip Code:62341-1137
Practice Address - Country:US
Practice Address - Phone:217-847-3931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist