Provider Demographics
NPI:1962668327
Name:LAGTAPON, MARIA THALIA TEVES (PT)
Entity Type:Individual
Prefix:MISS
First Name:MARIA THALIA
Middle Name:TEVES
Last Name:LAGTAPON
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 1:3625 SAINT JOSEPH RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9745
Mailing Address - Country:US
Mailing Address - Phone:812-948-0670
Mailing Address - Fax:
Practice Address - Street 1:3625 SAINT JOSEPH RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9745
Practice Address - Country:US
Practice Address - Phone:812-948-0670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007511A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist