Provider Demographics
NPI:1972704831
Name:NATIVIDAD, MAUREEN PAGKALIWANGAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:PAGKALIWANGAN
Last Name:NATIVIDAD
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 1:1034 W. SEMINARY AVE
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093
Mailing Address - Country:US
Mailing Address - Phone:410-252-7015
Mailing Address - Fax:570-739-2176
Practice Address - Street 1:200 E. NORTH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202
Practice Address - Country:US
Practice Address - Phone:443-984-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL8903225100000X
PAPT017694225100000X
MDPT22274225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO8903OtherPHYSICAL THERAPIST
PAPT017694OtherPHYSICAL THERAPIST