Provider Demographics
NPI:1407398001
Name:UBAYUBAY, DEONNE THADDEUS NOGUERRA (PT)
Entity Type:Individual
Prefix:
First Name:DEONNE THADDEUS
Middle Name:NOGUERRA
Last Name:UBAYUBAY
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 1:113 STIRLING LN
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-4827
Mailing Address - Country:US
Mailing Address - Phone:630-363-3136
Mailing Address - Fax:
Practice Address - Street 1:1102 S ROSELLE RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-4072
Practice Address - Country:US
Practice Address - Phone:847-882-1438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070022513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist