Healthcare Provider Details

I. General information

NPI: 1750862496
Provider Name (Legal Business Name): MERCEDITA LIWANAG PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3617 O HARE DR
MESQUITE TX
75150-4539
US

IV. Provider business mailing address

3402 CAPSTONE LN
GARLAND TX
75043-2886
US

V. Phone/Fax

Practice location:
  • Phone: 972-284-8600
  • Fax:
Mailing address:
  • Phone: 214-517-0735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1068534
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: