Provider Demographics
NPI:1396830105
Name:HIZON, MILDRED PAGUIA (RPT)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:PAGUIA
Last Name:HIZON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:MILDRED
Other - Middle Name:PAGUIA
Other - Last Name:HIZON-LOPE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPT
Mailing Address - Street 1:4166 TAMIAMI TRL
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4166 TAMIAMI TRL
Practice Address - Street 2:SUITE A
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9209
Practice Address - Country:US
Practice Address - Phone:941-766-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist