Provider Demographics
NPI:1932406865
Name:MARQUINA, RAY ANTHONY CARINO (PT)
Entity Type:Individual
Prefix:MR
First Name:RAY ANTHONY
Middle Name:CARINO
Last Name:MARQUINA
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 1:508 W 18TH ST
Mailing Address - Street 2:APT #2
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2648
Mailing Address - Country:US
Mailing Address - Phone:719-924-8942
Mailing Address - Fax:
Practice Address - Street 1:401 IDAHO AVE
Practice Address - Street 2:
Practice Address - City:ORDWAY
Practice Address - State:CO
Practice Address - Zip Code:81063-1328
Practice Address - Country:US
Practice Address - Phone:719-267-3561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist