Healthcare Provider Details

I. General information

NPI: 1366628000
Provider Name (Legal Business Name): EMALYN BACLIG REYES PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMALYN RAQUEPO BACLIG PT

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
SPRING CITY PA
19475-1241
US

IV. Provider business mailing address

1 VETERANS DR
SPRING CITY PA
19475-1241
US

V. Phone/Fax

Practice location:
  • Phone: 610-948-2585
  • Fax: 610-948-2643
Mailing address:
  • Phone: 610-948-2585
  • Fax: 610-948-2643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0292464
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT019218
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierLL676032
Identifier TypeOTHER
Identifier State
Identifier IssuerPASSPORT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: