Provider Demographics
NPI:1710399829
Name:MALLONGA, JULIO XAVIER RAAGAS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JULIO XAVIER
Middle Name:RAAGAS
Last Name:MALLONGA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:31 HALL DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2751
Mailing Address - Country:US
Mailing Address - Phone:413-256-8561
Mailing Address - Fax:866-644-0869
Practice Address - Street 1:31 HALL DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2751
Practice Address - Country:US
Practice Address - Phone:413-256-8561
Practice Address - Fax:866-644-0869
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23911225100000X, 225100000X
CA39821225100000X
OR06893225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist