Provider Demographics
NPI:1326389008
Name:MABUTAS, RICKY MARTINEZ (PT)
Entity Type:Individual
Prefix:MR
First Name:RICKY
Middle Name:MARTINEZ
Last Name:MABUTAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3700 TAYLOR GLEN LN NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-3400
Mailing Address - Country:US
Mailing Address - Phone:704-721-0478
Mailing Address - Fax:704-721-0479
Practice Address - Street 1:3700 TAYLOR GLEN LN NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-3400
Practice Address - Country:US
Practice Address - Phone:704-721-0478
Practice Address - Fax:704-721-0479
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP10624225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist