Provider Demographics
NPI:1376240598
Name:MAGDALENO, RAFAEL (PT)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:MAGDALENO
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 1:2 STRATHMORE DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-7022
Mailing Address - Country:US
Mailing Address - Phone:862-218-2827
Mailing Address - Fax:
Practice Address - Street 1:2 STRATHMORE DR
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-7022
Practice Address - Country:US
Practice Address - Phone:862-218-2827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041174-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty