Provider Demographics
NPI:1376928911
Name:MASANGKAY, MARIVIC MOTRIL (RPT)
Entity Type:Individual
Prefix:MS
First Name:MARIVIC
Middle Name:MOTRIL
Last Name:MASANGKAY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1580 SAWGRASS CORPORATE PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2859
Mailing Address - Country:US
Mailing Address - Phone:954-332-4445
Mailing Address - Fax:800-886-8108
Practice Address - Street 1:1580 SAWGRASS CORPORATE PKWY
Practice Address - Street 2:STE 100
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2859
Practice Address - Country:US
Practice Address - Phone:954-332-4445
Practice Address - Fax:800-886-8108
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI550107020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist