Provider Demographics
NPI:1952387425
Name:PAGKALIWANGAN, LILIAN JOSE (RPT)
Entity Type:Individual
Prefix:MRS
First Name:LILIAN
Middle Name:JOSE
Last Name:PAGKALIWANGAN
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 1:3885 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1109
Mailing Address - Country:US
Mailing Address - Phone:863-648-1186
Mailing Address - Fax:863-709-1416
Practice Address - Street 1:3885 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1109
Practice Address - Country:US
Practice Address - Phone:863-648-1186
Practice Address - Fax:863-709-1416
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT13022225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7691ZMedicare ID - Type Unspecified