Provider Demographics
NPI:1184025256
Name:PASTRANA, MARIA ROWENA (PT)
Entity Type:Individual
Prefix:
First Name:MARIA ROWENA
Middle Name:
Last Name:PASTRANA
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 1:1824 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3435
Mailing Address - Country:US
Mailing Address - Phone:708-761-6137
Mailing Address - Fax:708-923-1773
Practice Address - Street 1:8220 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1704
Practice Address - Country:US
Practice Address - Phone:708-761-6137
Practice Address - Fax:708-923-1773
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070008879225100000X
IN05001915A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist