Provider Demographics
NPI:1346464161
Name:WILSON, RHOBELLIE FLORENDO (PT)
Entity Type:Individual
Prefix:
First Name:RHOBELLIE
Middle Name:FLORENDO
Last Name:WILSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RHOBELLIE
Other - Middle Name:FLORENDO
Other - Last Name:SABERON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:10219 PINEWOOD AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2495
Mailing Address - Country:US
Mailing Address - Phone:818-331-3175
Mailing Address - Fax:310-398-5189
Practice Address - Street 1:12095 W. WASHINGTON BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5891
Practice Address - Country:US
Practice Address - Phone:310-398-3803
Practice Address - Fax:310-398-5189
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28536225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist