Provider Demographics
NPI:1831257690
Name:MARQUEZ, JUDY ANN V (PT)
Entity type:Individual
Prefix:MRS
First Name:JUDY ANN
Middle Name:V
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:JUDY
Other - Middle Name:V
Other - Last Name:MARQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 2188
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49016-2188
Mailing Address - Country:US
Mailing Address - Phone:269-288-0257
Mailing Address - Fax:269-962-0439
Practice Address - Street 1:229 NORTH AVENUE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017
Practice Address - Country:US
Practice Address - Phone:269-288-0257
Practice Address - Fax:269-962-0439
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI113891OtherPPOM
MI0007315715OtherAETNA
MI5633458OtherFIRST HEALTH
MI0007315715OtherAETNA
MI5633458OtherFIRST HEALTH