Provider Demographics
NPI:1669604989
Name:FAILAGUTAN, ANTONIETTE JOY CADIZ
Entity type:Individual
Prefix:
First Name:ANTONIETTE JOY
Middle Name:CADIZ
Last Name:FAILAGUTAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 LINGLESTOWN RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-9499
Mailing Address - Country:US
Mailing Address - Phone:717-829-1468
Mailing Address - Fax:
Practice Address - Street 1:2151 LINGLESTOWN RD
Practice Address - Street 2:SUITE 180
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9499
Practice Address - Country:US
Practice Address - Phone:717-829-1468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist