Provider Demographics
NPI:1881817831
Name:AGBAYANI, JOSE SOL OSERO (PT)
Entity Type:Individual
Prefix:
First Name:JOSE SOL
Middle Name:OSERO
Last Name:AGBAYANI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 WOODCREEK DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-6766
Mailing Address - Country:US
Mailing Address - Phone:717-691-6712
Mailing Address - Fax:717-506-0345
Practice Address - Street 1:210 BIG SPRING RD
Practice Address - Street 2:
Practice Address - City:NEWVILLE
Practice Address - State:PA
Practice Address - Zip Code:17241-9497
Practice Address - Country:US
Practice Address - Phone:717-776-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007902L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist