Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 5501007799 | MI |
N | 2251X0800X | Physical Therapist - Orthopedic | 5501007799 | MI |
NPI | 1407891344 |
---|---|
Provider Name | Gervacio Marasigan Laqui |
First Address | Sterling Heights, MI 48310-5853 |
Second Address | Sterling Heights, MI 48310-3591 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 08/07/2007 |