NPI 1003554759 · live from the CMS NPI Registry
John Malacad Abantao
Physical Therapist in Paxton, IL. National Provider Identifier 1003554759, active.
NPI record
| NPI | 1003554759 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physical Therapist 225100000X |
| Practice location | 1001 E Pells St, Paxton, IL 60957 |
| Practice phone | 217-379-4361 |
| Mailing address | 325 E 13th St, Gibson City, IL 60936 |
| Enumerated | May 23, 2022 |
| Last updated | May 23, 2022 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physical Therapist | 225100000X | 040925-01 (NY) |
| Physical Therapist primary | 225100000X | 070.024114 (IL) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.