Provider Demographics
NPI:1487194437
Name:PAGCALIWANGAN, HARIET AGUSTINO (RPT)
Entity Type:Individual
Prefix:
First Name:HARIET
Middle Name:AGUSTINO
Last Name:PAGCALIWANGAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12218 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4223
Mailing Address - Country:US
Mailing Address - Phone:954-706-1392
Mailing Address - Fax:
Practice Address - Street 1:12218 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4223
Practice Address - Country:US
Practice Address - Phone:954-706-1392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1287321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist