Healthcare Provider Details

I. General information

NPI: 1720787757
Provider Name (Legal Business Name): MELAH JAYNE LABUCA ARQUILLANO PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELAH JAYNE MABALATAN LABUCA PHYSICAL THERAPIST

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 02/28/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SYNCHRONY REHABILITATION 2701 CHESTNUT STATION COURT
LOUISVILLE KY
40299
US

IV. Provider business mailing address

10 GRANT STREET EXT
MILFORD MA
01757-2020
US

V. Phone/Fax

Practice location:
  • Phone: 800-335-1060
  • Fax:
Mailing address:
  • Phone: 508-498-2647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21790
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: