Healthcare Provider Details

I. General information

NPI: 1063632883
Provider Name (Legal Business Name): RAFAEL HILARIO ZANTUA OBUSAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 W. 117 ST. APT. 1B
NEW YORK NY
10026-2248
US

IV. Provider business mailing address

157 W 117 ST APT 1B
NEW YORK NY
10026-2248
US

V. Phone/Fax

Practice location:
  • Phone: 212-933-4205
  • Fax:
Mailing address:
  • Phone: 212-933-4205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number028076
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10036
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: