Individual
MR. BASILIO MARIO REYES CABILAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
NJ40QA01211500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NJPT40QA01211500
PHYSICAL THERAPY LICENSE
NJ
Enumeration date
04/11/2011
Last updated
04/11/2011
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