Provider Demographics
NPI:1790914588
Name:FABIAN, AMARYLLIS A (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMARYLLIS
Middle Name:A
Last Name:FABIAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:MARYL
Other - Middle Name:A
Other - Last Name:FABIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:597 3RD AVE.
Mailing Address - Street 2:CAPITAL DISTRICT BEGINNINGS
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12182
Mailing Address - Country:US
Mailing Address - Phone:518-233-0544
Mailing Address - Fax:
Practice Address - Street 1:597 3RD AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182
Practice Address - Country:US
Practice Address - Phone:518-233-0544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007775-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist