Provider Demographics
NPI:1134453533
Name:BUSIL, MARY CHRISTINE JOY ALOJIPAN (PT)
Entity type:Individual
Prefix:
First Name:MARY CHRISTINE JOY
Middle Name:ALOJIPAN
Last Name:BUSIL
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 1:4414 JOHN PENN CIR
Mailing Address - Street 2:APARTMENT I
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-1765
Mailing Address - Country:US
Mailing Address - Phone:910-622-7795
Mailing Address - Fax:
Practice Address - Street 1:4414 JOHN PENN CIR
Practice Address - Street 2:APARTMENT I
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-1765
Practice Address - Country:US
Practice Address - Phone:910-622-7795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11925225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
YPPW14779089OtherBLUECROSS BLUESHIELD