Provider Demographics
NPI:1104702711
Name:PASQUEL SALCEDO, JOAQUIN IVAN (PT)
Entity type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:IVAN
Last Name:PASQUEL SALCEDO
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 1:3016 HH RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-5204
Mailing Address - Country:US
Mailing Address - Phone:602-754-9156
Mailing Address - Fax:
Practice Address - Street 1:2133 S STATE ROUTE 157
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3607
Practice Address - Country:US
Practice Address - Phone:618-650-8337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.029269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist