Healthcare Provider Details

I. General information

NPI: 1083271779
Provider Name (Legal Business Name): NAIROBY BABILONIA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

D15 CALLE MCKINLEY URB FLAMBOYAN
MANATI PR
00674
US

IV. Provider business mailing address

113 CALLE A BO DOMINGUITO
ARECIBO PR
00612
US

V. Phone/Fax

Practice location:
  • Phone: 787-921-2543
  • Fax:
Mailing address:
  • Phone: 787-669-5141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number4517
License Number StatePR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: