Provider Demographics
NPI:1760603112
Name:KABAN, RISA MICHELLE (MS,PT)
Entity Type:Individual
Prefix:MRS
First Name:RISA
Middle Name:MICHELLE
Last Name:KABAN
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MANCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2265
Mailing Address - Country:US
Mailing Address - Phone:908-233-1349
Mailing Address - Fax:
Practice Address - Street 1:34 MANCHESTER DR
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2265
Practice Address - Country:US
Practice Address - Phone:908-233-1349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016585-1225100000X
NJ40QA01313700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist