Provider Demographics
NPI:1831364785
Name:PABONITA, MENIE SANTOS (BSPT)
Entity type:Individual
Prefix:MISS
First Name:MENIE
Middle Name:SANTOS
Last Name:PABONITA
Suffix:
Gender:F
Credentials:BSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 OLD SPRINGVILLE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-5858
Mailing Address - Country:US
Mailing Address - Phone:205-520-9600
Mailing Address - Fax:205-520-0455
Practice Address - Street 1:15117 HORN RD
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3886
Practice Address - Country:US
Practice Address - Phone:419-357-1667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028613-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist