Provider Demographics
NPI:1407039282
Name:ABUSTAN, ARLYN JEAN DOMINGO (RPT)
Entity Type:Individual
Prefix:MRS
First Name:ARLYN JEAN
Middle Name:DOMINGO
Last Name:ABUSTAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4359 147TH ST
Mailing Address - Street 2:LLF
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-1739
Mailing Address - Country:US
Mailing Address - Phone:718-445-3729
Mailing Address - Fax:718-445-8867
Practice Address - Street 1:4359 147TH ST
Practice Address - Street 2:LLF
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-1739
Practice Address - Country:US
Practice Address - Phone:718-445-3729
Practice Address - Fax:718-445-8867
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029917225100000X
CT008233225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist