Provider Demographics
NPI:1487862744
Name:BUENCONSEJO, MARIA GLORIA PADOR (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARIA GLORIA
Middle Name:PADOR
Last Name:BUENCONSEJO
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 1:9319 WATERS CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-7008
Mailing Address - Country:US
Mailing Address - Phone:260-489-3016
Mailing Address - Fax:
Practice Address - Street 1:9319 WATERS CT
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-7008
Practice Address - Country:US
Practice Address - Phone:260-489-3016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist