Provider Demographics
NPI:1336860816
Name:PATTUGALAN, MARIA TERESA MANUEL
Entity Type:Individual
Prefix:
First Name:MARIA TERESA
Middle Name:MANUEL
Last Name:PATTUGALAN
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 1:4813 LENOIR AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6015
Mailing Address - Country:US
Mailing Address - Phone:904-332-4546
Mailing Address - Fax:
Practice Address - Street 1:4813 LENOIR AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6015
Practice Address - Country:US
Practice Address - Phone:904-332-4546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist