Provider Demographics
NPI:1629345129
Name:QUIROGA, MARTHA (PT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:QUIROGA
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 1:3450 W CENTRAL AVE STE 131
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1420
Mailing Address - Country:US
Mailing Address - Phone:734-347-1547
Mailing Address - Fax:419-685-9087
Practice Address - Street 1:3450 W CENTRAL AVE STE 131
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1420
Practice Address - Country:US
Practice Address - Phone:734-347-1547
Practice Address - Fax:419-685-9087
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0039052251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic