Provider Demographics
NPI:1881122422
Name:CALCAGNO, MARIA PAULA (PTA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:PAULA
Last Name:CALCAGNO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 THREE ISLANDS BLVD APT 102
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-7328
Mailing Address - Country:US
Mailing Address - Phone:954-701-7964
Mailing Address - Fax:
Practice Address - Street 1:244 THREE ISLANDS BLVD APT 102
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-7328
Practice Address - Country:US
Practice Address - Phone:954-701-7964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA27596225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty