Provider Demographics
NPI:1265540249
Name:LIBUNAO, MARLON
Entity type:Individual
Prefix:
First Name:MARLON
Middle Name:
Last Name:LIBUNAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-1806
Mailing Address - Country:US
Mailing Address - Phone:864-335-9284
Mailing Address - Fax:
Practice Address - Street 1:110 BYPASS 225
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-1154
Practice Address - Country:US
Practice Address - Phone:864-223-0406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2892OtherLICENSE#