Provider Demographics
NPI:1629019740
Name:JAVIER, MYRA SHEILA BAQUIR (RPT)
Entity type:Individual
Prefix:
First Name:MYRA SHEILA
Middle Name:BAQUIR
Last Name:JAVIER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 GRASMERE DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-7639
Mailing Address - Country:US
Mailing Address - Phone:407-435-4167
Mailing Address - Fax:407-886-2152
Practice Address - Street 1:1822 GRASMERE DR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-7639
Practice Address - Country:US
Practice Address - Phone:407-435-4167
Practice Address - Fax:407-886-2152
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT15122225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00255860OtherRR MEDICARE
FLY090QOtherBCBS
FLU5636ZMedicare ID - Type UnspecifiedPT