Provider Demographics
NPI:1689676280
Name:AFANTE, ROSARIO GUMBAN (PT)
Entity type:Individual
Prefix:MRS
First Name:ROSARIO
Middle Name:GUMBAN
Last Name:AFANTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:ROSE
Other - Middle Name:G
Other - Last Name:AFANTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2213 N CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3730
Mailing Address - Country:US
Mailing Address - Phone:989-249-4009
Mailing Address - Fax:989-249-4588
Practice Address - Street 1:2213 N CENTER RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3730
Practice Address - Country:US
Practice Address - Phone:989-249-4009
Practice Address - Fax:989-249-4588
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4730131Medicaid
65 0G3 1175 0OtherBCBS
MI4730131Medicaid