Provider Demographics
NPI:1346712742
Name:CABONILAS, EVELYN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:
Last Name:CABONILAS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-3806
Mailing Address - Country:US
Mailing Address - Phone:570-735-2973
Mailing Address - Fax:
Practice Address - Street 1:395 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-3806
Practice Address - Country:US
Practice Address - Phone:570-735-2973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-23
Last Update Date:2018-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012194L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation