Provider Demographics
NPI:1770817207
Name:FAVOR, ARSENIO EUGENIO USI III (PT)
Entity type:Individual
Prefix:MR
First Name:ARSENIO EUGENIO
Middle Name:USI
Last Name:FAVOR
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3367 BILLIE CT
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2259
Mailing Address - Country:US
Mailing Address - Phone:196-716-6802
Mailing Address - Fax:196-716-6802
Practice Address - Street 1:3367 BILLIE CT
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2259
Practice Address - Country:US
Practice Address - Phone:196-716-6802
Practice Address - Fax:196-716-6802
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42476225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist