Provider Demographics
NPI:1558592790
Name:LAGMAN, MERCEDES LANTICAN (PT)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:LANTICAN
Last Name:LAGMAN
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 1:14 MALLARD CIR
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-8108
Mailing Address - Country:US
Mailing Address - Phone:774-535-1467
Mailing Address - Fax:
Practice Address - Street 1:26 HARVARD ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2833
Practice Address - Country:US
Practice Address - Phone:508-754-8877
Practice Address - Fax:508-756-0865
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist