Provider Demographics
NPI:1265737605
Name:MAGLAYA, PEARL ANGELINE TONGOL
Entity type:Individual
Prefix:
First Name:PEARL ANGELINE
Middle Name:TONGOL
Last Name:MAGLAYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 OLD SPRINGVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:AL
Mailing Address - Zip Code:35215-5858
Mailing Address - Country:US
Mailing Address - Phone:205-520-9600
Mailing Address - Fax:205-520-0455
Practice Address - Street 1:810 E 21ST ST
Practice Address - Street 2:SUITE 6
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4442
Practice Address - Country:US
Practice Address - Phone:970-854-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist