Provider Demographics
NPI:1871799379
Name:GOITI, MARY CELESTINE LASPINAS (PT)
Entity type:Individual
Prefix:
First Name:MARY CELESTINE
Middle Name:LASPINAS
Last Name:GOITI
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 1:303 NORTHCREST RD
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-9330
Mailing Address - Country:US
Mailing Address - Phone:219-448-0339
Mailing Address - Fax:
Practice Address - Street 1:770 N 075 E
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761-9359
Practice Address - Country:US
Practice Address - Phone:260-463-7445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007263A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist