Provider Demographics
NPI:1851887327
Name:ASTORGA, MAEVRYL CHARM MANGUSSAD (DPT)
Entity type:Individual
Prefix:MS
First Name:MAEVRYL
Middle Name:CHARM MANGUSSAD
Last Name:ASTORGA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MAEVRYL
Other - Middle Name:CHARM ERCE
Other - Last Name:MANGUSSAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1991 FORDHAM DR STE 102
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3774
Mailing Address - Country:US
Mailing Address - Phone:910-484-4653
Mailing Address - Fax:910-483-9256
Practice Address - Street 1:1991 FORDHAM DR STE 102
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3774
Practice Address - Country:US
Practice Address - Phone:910-484-4653
Practice Address - Fax:910-483-9256
Is Sole Proprietor?:No
Enumeration Date:2018-07-07
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10316225100000X
VACP042381T225100000X
NCCP043678T225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist