Provider Demographics
NPI:1053758367
Name:MAGBUHAT, MARY CHRISTINE GOROSPE (PT)
Entity type:Individual
Prefix:
First Name:MARY CHRISTINE
Middle Name:GOROSPE
Last Name:MAGBUHAT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 ORCHARD AVENUE
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193
Mailing Address - Country:US
Mailing Address - Phone:847-284-5273
Mailing Address - Fax:
Practice Address - Street 1:1606 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-6319
Practice Address - Country:US
Practice Address - Phone:847-284-5273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070019087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist