Provider Demographics
NPI:1538137377
Name:ABELLANOSA, REYMAR FABURADA (PT)
Entity Type:Individual
Prefix:MR
First Name:REYMAR
Middle Name:FABURADA
Last Name:ABELLANOSA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N CROOKS RD
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1352
Mailing Address - Country:US
Mailing Address - Phone:248-854-9835
Mailing Address - Fax:248-435-9023
Practice Address - Street 1:300 N CROOKS RD
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-1357
Practice Address - Country:US
Practice Address - Phone:248-854-9835
Practice Address - Fax:248-435-9023
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist