Provider Demographics
NPI:1790228120
Name:LIWAG, MARY CATHERINE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARY CATHERINE
Middle Name:
Last Name:LIWAG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 SNEDEN PL W
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-3970
Mailing Address - Country:US
Mailing Address - Phone:845-558-9138
Mailing Address - Fax:
Practice Address - Street 1:845 PALMER AVE
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-2406
Practice Address - Country:US
Practice Address - Phone:914-698-6005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-03
Last Update Date:2024-09-30
Deactivation Date:2021-06-02
Deactivation Code:
Reactivation Date:2024-09-30
Provider Licenses
StateLicense IDTaxonomies
NY041018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist