MEDICARE: LOWELL S LIWANAG RPT, WCC, CWS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT11021	FL

General Provider Information

NPI Number	:	1780600155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOWELL S LIWANAG RPT, WCC, CWS

Provider Business Mailing Address
First Line	:	PO BOX 1168
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33859-1168
Country	:	US
Telephone Number	:	863-678-1557
Fax Number	:	863-582-9279

Provider Business Practice Location Address
First Line	:	2027 STATE ROAD 60 E
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33898-5113
Country	:	US
Telephone Number	:	863-678-1557
Fax Number	:	863-676-2077

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	07/10/2008

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