Provider Demographics
NPI:1538474341
Name:TIBON, CITADEL CABALAN (PT)
Entity Type:Individual
Prefix:
First Name:CITADEL
Middle Name:CABALAN
Last Name:TIBON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 W 135TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-2922
Mailing Address - Country:US
Mailing Address - Phone:212-281-8678
Mailing Address - Fax:
Practice Address - Street 1:131 W 135TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-2922
Practice Address - Country:US
Practice Address - Phone:212-281-8678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist