Provider Demographics
NPI:1386765568
Name:LANSANGAN, MARTIN EUGENE (PT)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:EUGENE
Last Name:LANSANGAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 WIMBERLY WAY
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3438
Mailing Address - Country:US
Mailing Address - Phone:936-273-6112
Mailing Address - Fax:
Practice Address - Street 1:1120 MEDICAL PLAZA DR STE 180
Practice Address - Street 2:WOODLANDS PROFESSIONAL CENTER
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3250
Practice Address - Country:US
Practice Address - Phone:281-364-9041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1116234225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T0573OtherBCBS NUMBER
TX8D5696Medicare ID - Type UnspecifiedMIDICARE NUMBER