Provider Demographics
NPI:1780887505
Name:JUNQUERA, RALPH EDWARD SABALLA (PT)
Entity type:Individual
Prefix:MR
First Name:RALPH EDWARD
Middle Name:SABALLA
Last Name:JUNQUERA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1513 KELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61705
Mailing Address - Country:US
Mailing Address - Phone:309-319-1405
Mailing Address - Fax:
Practice Address - Street 1:510 BROADWAY ST. , MANOR CARE REHAB AND NURSING
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61716-3816
Practice Address - Country:US
Practice Address - Phone:309-452-4406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2021-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.015244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist