Provider Demographics
NPI:1750862496
Name:LIWANAG, MERCEDITA (PT)
Entity type:Individual
Prefix:
First Name:MERCEDITA
Middle Name:
Last Name:LIWANAG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 CAPSTONE LN
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-2886
Mailing Address - Country:US
Mailing Address - Phone:214-517-0735
Mailing Address - Fax:
Practice Address - Street 1:3617 O HARE DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4539
Practice Address - Country:US
Practice Address - Phone:972-284-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1068534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist