Provider Demographics
NPI:1720020183
Name:PANGALANGAN, WALTER RAPHAEL (PT)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:RAPHAEL
Last Name:PANGALANGAN
Suffix:
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:PO BOX 976
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488
Mailing Address - Country:US
Mailing Address - Phone:843-549-6487
Mailing Address - Fax:843-542-9727
Practice Address - Street 1:205 MEADOW STREET
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488
Practice Address - Country:US
Practice Address - Phone:843-549-6487
Practice Address - Fax:843-542-9727
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC43482251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1626Medicare ID - Type Unspecified
SCQ328100281Medicare ID - Type UnspecifiedSPIN