Provider Demographics
NPI:1831832310
Name:MAJABAGUE, JOHAN LYN ABENDANO (PT, DPT)
Entity type:Individual
Prefix:
First Name:JOHAN LYN
Middle Name:ABENDANO
Last Name:MAJABAGUE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8610 54TH AVE # 1F
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4335
Mailing Address - Country:US
Mailing Address - Phone:401-935-8616
Mailing Address - Fax:
Practice Address - Street 1:8610 54TH AVE # 1F
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4335
Practice Address - Country:US
Practice Address - Phone:401-935-8616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041357-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist