Provider Demographics
NPI:1184873713
Name:PABALATE, LIZA MARIE MANALO (PT)
Entity type:Individual
Prefix:
First Name:LIZA MARIE
Middle Name:MANALO
Last Name:PABALATE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LIZA
Other - Middle Name:
Other - Last Name:PABALATE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:3624 AUSTIN PEAY HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-3776
Mailing Address - Country:US
Mailing Address - Phone:901-372-7324
Mailing Address - Fax:901-372-7326
Practice Address - Street 1:3624 AUSTIN PEAY HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-3776
Practice Address - Country:US
Practice Address - Phone:901-372-7324
Practice Address - Fax:901-372-7326
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN02337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist