Provider Demographics
NPI:1528121787
Name:CABARLO, REYNALDO CABANILLA (RPT)
Entity type:Individual
Prefix:MR
First Name:REYNALDO
Middle Name:CABANILLA
Last Name:CABARLO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:MR
Other - First Name:REYNALDO
Other - Middle Name:CABANILLA
Other - Last Name:CABARLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPT
Mailing Address - Street 1:PO BOX 1170
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-1170
Mailing Address - Country:US
Mailing Address - Phone:931-879-4301
Mailing Address - Fax:931-879-4302
Practice Address - Street 1:403 WEST CENTRAL AVE.
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-1170
Practice Address - Country:US
Practice Address - Phone:931-879-4301
Practice Address - Fax:931-879-4302
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT1466225100000X
TN1466225100000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0063840OtherBCBS
TN4448120Medicaid
TN4448120Medicaid