Provider Demographics
NPI:1811066558
Name:MARQUEZ, DEBRA F (MS MPT)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:F
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:MS MPT
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:F
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS MPT
Mailing Address - Street 1:1673 W SHORELINE DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702
Mailing Address - Country:US
Mailing Address - Phone:208-343-4700
Mailing Address - Fax:208-343-4706
Practice Address - Street 1:1673 W SHORELINE DR
Practice Address - Street 2:SUITE 230
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702
Practice Address - Country:US
Practice Address - Phone:208-343-4700
Practice Address - Fax:208-343-4706
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
IDPT1247225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist