Provider Demographics
NPI:1154131811
Name:PABELLANO, MERVIN RAPHAEL MARQUEZ
Entity type:Individual
Prefix:
First Name:MERVIN RAPHAEL
Middle Name:MARQUEZ
Last Name:PABELLANO
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 1:6621 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2050
Mailing Address - Country:US
Mailing Address - Phone:304-942-7221
Mailing Address - Fax:
Practice Address - Street 1:6621 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2050
Practice Address - Country:US
Practice Address - Phone:304-942-7221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist