Provider Demographics
NPI:1962199059
Name:PANGILINAN, MARK FRANCIS SARMIENTO (DPT)
Entity type:Individual
Prefix:
First Name:MARK FRANCIS
Middle Name:SARMIENTO
Last Name:PANGILINAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:882 REFLECTIONS LOOP E
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-3567
Mailing Address - Country:US
Mailing Address - Phone:863-969-8266
Mailing Address - Fax:
Practice Address - Street 1:425 S 11TH ST STE 3
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4239
Practice Address - Country:US
Practice Address - Phone:863-676-0174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL39932225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist