Provider Demographics
NPI:1083079552
Name:MCPHILOMY, MABELLE TERCERO
Entity Type:Individual
Prefix:
First Name:MABELLE
Middle Name:TERCERO
Last Name:MCPHILOMY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MABELLE
Other - Middle Name:BAGUIO
Other - Last Name:TERCERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:177 BRENTLEY LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-5615
Mailing Address - Country:US
Mailing Address - Phone:951-796-7268
Mailing Address - Fax:
Practice Address - Street 1:177 BRENTLEY LN
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-5615
Practice Address - Country:US
Practice Address - Phone:951-796-7268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT308612251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics