Provider Demographics
NPI:1992137657
Name:LALIC, MARIA SOLEDAD C (PT)
Entity type:Individual
Prefix:MRS
First Name:MARIA SOLEDAD
Middle Name:C
Last Name:LALIC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARIA SOLEDAD
Other - Middle Name:L
Other - Last Name:DELOS REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:3018 FESTIVAL WAY # 323
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2958
Practice Address - Country:US
Practice Address - Phone:240-754-5520
Practice Address - Fax:301-705-6797
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP12892225100000X
MD26924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty