Provider Demographics
NPI:1902057995
Name:FUCANAN, MARIA CHRISTINA BALABAG (PT)
Entity Type:Individual
Prefix:
First Name:MARIA CHRISTINA
Middle Name:BALABAG
Last Name:FUCANAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARIA CHRISTINA
Other - Middle Name:FUCANAN
Other - Last Name:MANALANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:3290 NORTH RIDGE ROAD
Mailing Address - Street 2:#290 EXECUTIVE CENTER II
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043
Mailing Address - Country:US
Mailing Address - Phone:410-988-5819
Mailing Address - Fax:
Practice Address - Street 1:3290 NORTH RIDGE ROAD
Practice Address - Street 2:#290 EXECUTIVE CENTER II
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043
Practice Address - Country:US
Practice Address - Phone:410-988-5819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24328225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist