Individual
MRS. JEANZEN MICHELLE LINTAG RAQUENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
J1-0002167
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164694402
—
DE
01
—
12033691
CAQH
—
01
—
295853
UNISON
DE
01
—
3761297000
IBC PERSONAL CHOICE
—
Enumeration date
03/27/2008
Last updated
03/15/2011
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