Provider Demographics
NPI:1750860672
Name:MAGBITANG, KRISTOFFER RYAN (PTA)
Entity type:Individual
Prefix:MR
First Name:KRISTOFFER
Middle Name:RYAN
Last Name:MAGBITANG
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:MR
Other - First Name:KRISTOFFER
Other - Middle Name:RYAN
Other - Last Name:MAGBITANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:2623 PRIMAVERA DR
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-9297
Mailing Address - Country:US
Mailing Address - Phone:661-370-5998
Mailing Address - Fax:
Practice Address - Street 1:1509 TOKAY ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-3603
Practice Address - Country:US
Practice Address - Phone:661-720-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTA9212225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant