Provider Demographics
NPI:1487203188
Name:MACASAET, RUBYANN PASTORAL
Entity Type:Individual
Prefix:
First Name:RUBYANN
Middle Name:PASTORAL
Last Name:MACASAET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RUBYANN
Other - Middle Name:OGALINO
Other - Last Name:PASTORAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 CABANA WAY
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1849 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-3109
Practice Address - Country:US
Practice Address - Phone:850-682-5322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34647225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist