Basic Information
| Provider Information | |||||||||
| NPI: | 1912497579 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TUBAYAN | ||||||||
| FirstName: | GIRLY | ||||||||
| MiddleName: | ORLANDO | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12218 W SAMPLE RD | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330654223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7543023875 | ||||||||
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| Practice Location | |||||||||
| Address1: | 613 EAKER STREET | ||||||||
| Address2: | |||||||||
| City: | EDEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3258695531 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2018 | ||||||||
| LastUpdateDate: | 05/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2137053 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.