Provider Demographics
NPI:1144657628
Name:LIWANAG, JEAN LOIS SIGUA (PT)
Entity type:Individual
Prefix:MRS
First Name:JEAN LOIS
Middle Name:SIGUA
Last Name:LIWANAG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9944 ADVENTURE PASS
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-2224
Mailing Address - Country:US
Mailing Address - Phone:443-825-6771
Mailing Address - Fax:
Practice Address - Street 1:9944 ADVENTURE PASS
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-2224
Practice Address - Country:US
Practice Address - Phone:443-825-6771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010743A225100000X
MD21902225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist