Provider Demographics
NPI:1992526339
Name:CALAGO, QUENNIE LYNN TABARANZA (PT)
Entity type:Individual
Prefix:
First Name:QUENNIE LYNN
Middle Name:TABARANZA
Last Name:CALAGO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:QUENNIE LYNN
Other - Middle Name:QUIJANO
Other - Last Name:TABARANZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3524 MEADOW GLEN CT
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-3000
Mailing Address - Country:US
Mailing Address - Phone:336-677-8854
Mailing Address - Fax:
Practice Address - Street 1:117 SHARON RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-4000
Practice Address - Country:US
Practice Address - Phone:203-756-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14407225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist