Provider Demographics
NPI:1861646184
Name:URQUICO, GERALD REYNON (PT)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:REYNON
Last Name:URQUICO
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 1:2489 LADOGA DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-9540
Mailing Address - Country:US
Mailing Address - Phone:863-617-3332
Mailing Address - Fax:855-300-5536
Practice Address - Street 1:6021 W. CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108
Practice Address - Country:US
Practice Address - Phone:702-658-9494
Practice Address - Fax:702-658-9419
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014866225100000X
FLPT26708225100000X
NV2231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist