Provider Demographics
NPI:1912194762
Name:ALQUIZALAS, EARL JE BACUS (RPT)
Entity Type:Individual
Prefix:
First Name:EARL JE
Middle Name:BACUS
Last Name:ALQUIZALAS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 LAKEVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-4701
Mailing Address - Country:US
Mailing Address - Phone:702-768-8356
Mailing Address - Fax:
Practice Address - Street 1:82 MAIN AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:CO
Practice Address - Zip Code:80720-1440
Practice Address - Country:US
Practice Address - Phone:702-768-8356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist