Provider Demographics
NPI:1497037188
Name:CUSTODIO, KERWIN NOEL PAYABYAB (PT)
Entity Type:Individual
Prefix:
First Name:KERWIN NOEL
Middle Name:PAYABYAB
Last Name:CUSTODIO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5716 CRAWLEY LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-1535
Mailing Address - Country:US
Mailing Address - Phone:432-288-3974
Mailing Address - Fax:
Practice Address - Street 1:2600 ELDORADO PKWY STE 130
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-7517
Practice Address - Country:US
Practice Address - Phone:972-984-7670
Practice Address - Fax:972-984-7671
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX11909522251N0400X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic