Provider Demographics
NPI:1740544519
Name:BALAGOT, MARIA LOURDES NERA (PT)
Entity type:Individual
Prefix:
First Name:MARIA LOURDES
Middle Name:NERA
Last Name:BALAGOT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LOURDES
Other - Middle Name:NERA
Other - Last Name:BALAGOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2012 S TOLLGATE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-5902
Mailing Address - Country:US
Mailing Address - Phone:410-638-1000
Mailing Address - Fax:
Practice Address - Street 1:2012 S TOLLGATE RD STE 205
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-5902
Practice Address - Country:US
Practice Address - Phone:410-638-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD170892251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic