Provider Demographics
NPI:1699350470
Name:BANDOQUILLO, TRIXIA JOYCE TOROTORO (PT)
Entity type:Individual
Prefix:
First Name:TRIXIA JOYCE
Middle Name:TOROTORO
Last Name:BANDOQUILLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16244 S MILITARY TRL STE 750
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6532
Mailing Address - Country:US
Mailing Address - Phone:561-496-7993
Mailing Address - Fax:
Practice Address - Street 1:16244 S MILITARY TRL STE 750
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6532
Practice Address - Country:US
Practice Address - Phone:561-496-7993
Practice Address - Fax:561-496-0589
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-13
Last Update Date:2023-03-01
Deactivation Date:2021-04-24
Deactivation Code:
Reactivation Date:2023-03-01
Provider Licenses
StateLicense IDTaxonomies
CT13019225100000X
FLPT35515225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist