Provider Demographics
NPI:1437449550
Name:CABILAO, BASILIO MARIO REYES (PT)
Entity type:Individual
Prefix:MR
First Name:BASILIO MARIO
Middle Name:REYES
Last Name:CABILAO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 E LIBERTY ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-5122
Mailing Address - Country:US
Mailing Address - Phone:862-224-1084
Mailing Address - Fax:
Practice Address - Street 1:6 E. LIBERTY ST.
Practice Address - Street 2:2ND FLR.
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003
Practice Address - Country:US
Practice Address - Phone:862-224-1084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ40QA01211500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJNJPT40QA01211500OtherPHYSICAL THERAPY LICENSE