1720787757 NPI number — MELAH JAYNE LABUCA ARQUILLANO PHYSICAL THERAPIST

Table of content: MELAH JAYNE LABUCA ARQUILLANO PHYSICAL THERAPIST (NPI 1720787757)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720787757 NPI number — MELAH JAYNE LABUCA ARQUILLANO PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
ARQUILLANO

Provider First Name:
MELAH JAYNE

Provider Middle Name:
LABUCA

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:
PHYSICAL THERAPIST

Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:
LABUCA

Provider Other First Name:
MELAH JAYNE

Provider Other Middle Name:
MABALATAN

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:
PHYSICAL THERAPIST

Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720787757

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
02/28/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 GRANT STREET EXT

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
MILFORD

Provider Business Mailing Address State Name:
MA

Provider Business Mailing Address Postal Code:
01757-2020

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
508-498-2647

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SYNCHRONY REHABILITATION

Provider Second Line Business Practice Location Address:
2701 CHESTNUT STATION COURT

Provider Business Practice Location Address City Name:
LOUISVILLE

Provider Business Practice Location Address State Name:
KY

Provider Business Practice Location Address Postal Code:
40299

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
800-335-1060

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
02/28/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

Provider Taxonomy Codes

Taxonomy code: 225100000X , with the licence number: 21790 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .