Provider Demographics
NPI:1023571890
Name:ALBISO, AWSTON (DPT)
Entity Type:Individual
Prefix:
First Name:AWSTON
Middle Name:
Last Name:ALBISO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10849 ZINFANDEL ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-3892
Mailing Address - Country:US
Mailing Address - Phone:909-965-5530
Mailing Address - Fax:
Practice Address - Street 1:10849 ZINFANDEL ST
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737-3892
Practice Address - Country:US
Practice Address - Phone:909-965-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT296372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist