Provider Demographics
NPI:1427279041
Name:PANGANIBAN, MA CORAZON (PT)
Entity type:Individual
Prefix:MISS
First Name:MA CORAZON
Middle Name:
Last Name:PANGANIBAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:CORA
Other - Middle Name:
Other - Last Name:PANGANIBAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-0194
Mailing Address - Country:US
Mailing Address - Phone:901-476-1241
Mailing Address - Fax:
Practice Address - Street 1:188 PROSSER RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4233
Practice Address - Country:US
Practice Address - Phone:931-766-3279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5005225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist