Provider Demographics
NPI:1972226744
Name:HAYDOCK, MARYGRACE PAGGAO (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MISS
First Name:MARYGRACE
Middle Name:PAGGAO
Last Name:HAYDOCK
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:MISS
Other - First Name:MARYGRACE
Other - Middle Name:CALAYCAY
Other - Last Name:PAGGAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:509 E JOPPA RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5404
Mailing Address - Country:US
Mailing Address - Phone:410-828-1740
Mailing Address - Fax:
Practice Address - Street 1:509 E JOPPA RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5404
Practice Address - Country:US
Practice Address - Phone:410-828-9494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist