Provider Demographics
NPI:1760744429
Name:CASIBANG, BASILIA MAGDALENA (PT)
Entity Type:Individual
Prefix:MRS
First Name:BASILIA
Middle Name:MAGDALENA
Last Name:CASIBANG
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 1:9747 PANTHER HOLLOW ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-8709
Mailing Address - Country:US
Mailing Address - Phone:702-964-0333
Mailing Address - Fax:
Practice Address - Street 1:9747 PANTHER HOLLOW ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-8709
Practice Address - Country:US
Practice Address - Phone:702-964-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist