Provider Demographics
NPI:1992040828
Name:APOSTOL, MARK CARL TABLIAGO (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK CARL
Middle Name:TABLIAGO
Last Name:APOSTOL
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 1:620 EMERALD STREET, GREENHEIGHTS SUBD,
Mailing Address - Street 2:
Mailing Address - City:NOVALICHES
Mailing Address - State:QUEZON CITY
Mailing Address - Zip Code:1116
Mailing Address - Country:PH
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2423 85TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-3503
Practice Address - Country:US
Practice Address - Phone:347-235-7730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034872-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist