Healthcare Provider Details

I. General information

NPI: 1144657628
Provider Name (Legal Business Name): JEAN LOIS SIGUA LIWANAG PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9944 ADVENTURE PASS
NOBLESVILLE IN
46060-2224
US

IV. Provider business mailing address

9944 ADVENTURE PASS
NOBLESVILLE IN
46060-2224
US

V. Phone/Fax

Practice location:
  • Phone: 443-825-6771
  • Fax:
Mailing address:
  • Phone: 443-825-6771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05010743A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21902
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: