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General NPI Number Information
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NPI Number | 1497037188
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Entity Type | Individual
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Provider Name | KERWIN NOEL PAYABYAB CUSTODIO P.T.
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Gender | Male
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Dates
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Enumeration Date | 09/19/2011
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Last Update Date | 12/16/2022
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Provider Practice Location Address
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Address Line | 2600 ELDORADO PKWY STE 130
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City | MCKINNEY
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State | TX
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Zip | 75070-7517
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Country | US
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Telephone | 972-984-7670
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Fax | 972-984-7671
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Provider Business Mailing Address
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Address Line | 5716 CRAWLEY LN
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City | MCKINNEY
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State | TX
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Zip | 75071-1535
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Country | US
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Telephone | 432-288-3974
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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 | 2251N0400X
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Taxonomy Name | Neurology Physical Therapist
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License Number | 1190952
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1190952
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1190952
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License Number State | TX
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