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General NPI Number Information
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NPI Number | 1437449550
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Entity Type | Individual
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Provider Name | BASILIO MARIO REYES CABILAO PT
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Gender | Male
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 6 E. LIBERTY ST. 2ND FLR.
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City | BLOOMFIELD
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State | NJ
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Zip | 07003
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Country | US
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Telephone | 862-224-1084
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Fax |
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Provider Business Mailing Address
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Address Line | 6 E LIBERTY ST 2ND FLOOR
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-5122
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Country | US
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Telephone | 862-224-1084
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | NJ40QA01211500
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License Number State | NJ
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