Provider Demographics
NPI:1669280848
Name:UNABIA, LOVELY ROULETTE EDULLANTES (PT)
Entity type:Individual
Prefix:MRS
First Name:LOVELY ROULETTE
Middle Name:EDULLANTES
Last Name:UNABIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:LOVELY ROULETTE
Other - Middle Name:UNABIA
Other - Last Name:ABELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1004 S DURKIN DR APT 11
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-1309
Mailing Address - Country:US
Mailing Address - Phone:217-801-7409
Mailing Address - Fax:
Practice Address - Street 1:46 BROOKMEADE DR
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-2317
Practice Address - Country:US
Practice Address - Phone:217-801-7409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist