Provider Demographics
NPI:1821242868
Name:ENRIQUEZ, JOJIT TANQUERIDO (PT)
Entity Type:Individual
Prefix:
First Name:JOJIT
Middle Name:TANQUERIDO
Last Name:ENRIQUEZ
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 1:3201 W COMMERCIAL BLVD
Mailing Address - Street 2:#116
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3440
Mailing Address - Country:US
Mailing Address - Phone:954-739-4247
Mailing Address - Fax:
Practice Address - Street 1:3201 W COMMERCIAL BLVD
Practice Address - Street 2:#116
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3440
Practice Address - Country:US
Practice Address - Phone:954-739-4247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist