Provider Demographics
NPI:1912183930
Name:CABILAN, IAN PAT ANACLETO (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:IAN PAT
Middle Name:ANACLETO
Last Name:CABILAN
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Gender:M
Credentials:PHYSICAL THERAPIST
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Mailing Address - Street 1:8811 53RD AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4517
Mailing Address - Country:US
Mailing Address - Phone:917-291-9301
Mailing Address - Fax:718-606-9389
Practice Address - Street 1:8811 53RD AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4517
Practice Address - Country:US
Practice Address - Phone:917-291-9301
Practice Address - Fax:718-606-9389
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY025383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist