Provider Demographics
NPI:1699817288
Name:SIQUEIRA, MARCO ANTONIO DE FRANCHI (PT)
Entity Type:Individual
Prefix:MR
First Name:MARCO ANTONIO
Middle Name:DE FRANCHI
Last Name:SIQUEIRA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:MARCO ANTONIO
Other - Middle Name:DE FRANCHI
Other - Last Name:SIQUIERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:17100 COLLINS AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3675
Mailing Address - Country:US
Mailing Address - Phone:305-947-7788
Mailing Address - Fax:305-947-5458
Practice Address - Street 1:17100 COLLINS AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-3675
Practice Address - Country:US
Practice Address - Phone:305-947-7788
Practice Address - Fax:305-947-5458
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT2217225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891059600Medicaid
FLY6116ZMedicare ID - Type UnspecifiedPHYSICAL THERAPIST