Healthcare Provider Details

I. General information

NPI: 1528121787
Provider Name (Legal Business Name): REYNALDO CABANILLA CABARLO RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: REYNALDO CABANILLA CABARLO RPT

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 WEST CENTRAL AVE.
JAMESTOWN TN
38556-1170
US

IV. Provider business mailing address

PO BOX 1170
JAMESTOWN TN
38556-1170
US

V. Phone/Fax

Practice location:
  • Phone: 931-879-4301
  • Fax: 931-879-4302
Mailing address:
  • Phone: 931-879-4301
  • Fax: 931-879-4302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1466
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1466
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1466
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: