Provider Demographics
NPI:1336784909
Name:MAGLANQUE, NAZARIO II (PT)
Entity Type:Individual
Prefix:MR
First Name:NAZARIO
Middle Name:
Last Name:MAGLANQUE
Suffix:II
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 CARPENTER DR STE 210
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4910
Mailing Address - Country:US
Mailing Address - Phone:404-565-2266
Mailing Address - Fax:866-929-8332
Practice Address - Street 1:275 CARPENTER DR STE 210
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4910
Practice Address - Country:US
Practice Address - Phone:404-565-2266
Practice Address - Fax:866-929-8332
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist