Provider Demographics
NPI:1932128451
Name:CABAHUG, MYRA MONSALES (PT)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:MONSALES
Last Name:CABAHUG
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 1:3939 BEECHWOOD PL
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2026
Mailing Address - Country:US
Mailing Address - Phone:516-509-6291
Mailing Address - Fax:
Practice Address - Street 1:3939 BEECHWOOD PL
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-2026
Practice Address - Country:US
Practice Address - Phone:516-509-6291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist