Provider Demographics
NPI:1679757843
Name:CABARLO, MARIFE CANDELARIA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:MARIFE
Middle Name:CANDELARIA
Last Name:CABARLO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:MRS
Other - First Name:MARIFE
Other - Middle Name:CANDELARIA
Other - Last Name:CABARLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:PO BOX 1170
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-1170
Mailing Address - Country:US
Mailing Address - Phone:931-879-4301
Mailing Address - Fax:
Practice Address - Street 1:403 W. CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-1170
Practice Address - Country:US
Practice Address - Phone:931-879-4302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1459225100000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4448120Medicaid