Individual
KENNETH LLANOS FABUGAIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1620 COUNTRY CLUB RD, VALPARAISO, IN 46383-8427
(219) 548-4663
Mailing address
1620 COUNTRY CLUB RD, VALPARAISO, IN 46383-8427
(219) 548-4663
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05004854A
IN
Other
Enumeration date
01/24/2018
Last updated
01/24/2018
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