Provider Demographics
NPI:1922633122
Name:SUBLAY, JEWEL BUENAFE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:JEWEL
Middle Name:BUENAFE
Last Name:SUBLAY
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 FREEDOM DR
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-6866
Mailing Address - Country:US
Mailing Address - Phone:505-728-0539
Mailing Address - Fax:
Practice Address - Street 1:3720 CHURCH ROCK ST
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4572
Practice Address - Country:US
Practice Address - Phone:505-722-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-08
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4082225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist