Provider Demographics
NPI:1912345182
Name:MADANGUIT, MARY CATHLEEN ACADEMIA (RPT)
Entity Type:Individual
Prefix:
First Name:MARY CATHLEEN
Middle Name:ACADEMIA
Last Name:MADANGUIT
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2079 DEER VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-1598
Mailing Address - Country:US
Mailing Address - Phone:812-498-8412
Mailing Address - Fax:
Practice Address - Street 1:2079 DEER VALLEY CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-1598
Practice Address - Country:US
Practice Address - Phone:812-498-8412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011126A225100000X
KS1104481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist