Provider Demographics
NPI:1700280740
Name:MAGBAGO, HONEY QUEEN
Entity Type:Individual
Prefix:
First Name:HONEY QUEEN
Middle Name:
Last Name:MAGBAGO
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 1:840 PATMAR DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-2132
Mailing Address - Country:US
Mailing Address - Phone:623-570-3403
Mailing Address - Fax:
Practice Address - Street 1:840 PATMAR DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17046-2132
Practice Address - Country:US
Practice Address - Phone:623-570-3403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ2-0000911225200000X
PATEI005072225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant