Provider Demographics
NPI:1417223736
Name:INSULAR, BETSY MAGNO (DPT)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:MAGNO
Last Name:INSULAR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARIA BETSY
Other - Middle Name:MAGNO
Other - Last Name:INSULAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:1118 N AVALON BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-3520
Mailing Address - Country:US
Mailing Address - Phone:310-308-3828
Mailing Address - Fax:310-807-9295
Practice Address - Street 1:1118 N AVALON BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-3520
Practice Address - Country:US
Practice Address - Phone:310-308-3828
Practice Address - Fax:310-807-9295
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 32478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist