Provider Demographics
NPI:1407521669
Name:FRANCO, MARYVIC PACULANAN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MARYVIC
Middle Name:PACULANAN
Last Name:FRANCO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3161 DUXBURY LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-3746
Mailing Address - Country:US
Mailing Address - Phone:863-450-0714
Mailing Address - Fax:
Practice Address - Street 1:3161 DUXBURY LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-3746
Practice Address - Country:US
Practice Address - Phone:863-450-0714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist