Provider Demographics
NPI:1063632883
Name:OBUSAN, RAFAEL HILARIO ZANTUA (PT)
Entity Type:Individual
Prefix:MR
First Name:RAFAEL HILARIO
Middle Name:ZANTUA
Last Name:OBUSAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 W 117 ST
Mailing Address - Street 2:APT 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2248
Mailing Address - Country:US
Mailing Address - Phone:212-933-4205
Mailing Address - Fax:
Practice Address - Street 1:157 W. 117 ST.
Practice Address - Street 2:APT. 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-2248
Practice Address - Country:US
Practice Address - Phone:212-933-4205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028076225100000X
NC10036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist