Mary Ann Sibug Honculada

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-123 Issued in GU

Practice address

#155 E.T. Calvo Memorial Pkwy, Ste #102
Tamuning, GU 96913

Phone

(671) 477-3472

Fax

(671) 477-3473

NPI assigned

May 12, 2016

Last updated

Nov 3, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Mary Ann Policarpio Sibug Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Active Life Chiropractic and Physical Therapy

  • Physical Therapist
  • Tamuning, GU
  • NPI 1760831606
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635897600000",
    "number": "1104272731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 FARENHOLT AVE., SUITE G PMB 90",
            "city": "TAMUNING",
            "state": "GU",
            "postal_code": "969133217",
            "telephone_number": "671-477-3472",
            "fax_number": "671-477-3473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "#155 E.T. CALVO MEMORIAL PKWY, STE #102",
            "city": "TAMUNING",
            "state": "GU",
            "postal_code": "96913",
            "telephone_number": "671-477-3472",
            "fax_number": "671-477-3473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HONCULADA",
        "first_name": "MARY ANN",
        "middle_name": "SIBUG",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-12",
        "last_updated": "2021-11-03",
        "certification_date": "2021-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "GU",
            "license": "PT-123",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GU",
            "license": "PT-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY ANN",
            "last_name": "SIBUG",
            "middle_name": "POLICARPIO",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Diane M Hiatt, FNP
• Edgardo C Hidalgo, MD
• William Clayton Hightower II, D.D.S.
• Megumi Homma, DC
• Joshua Honculada
• David D.Y. Hong, P.A.
• Rai Bok Hong, M.D.
• Keith M Horinouchi, M.N.T.
• Hunterspeaks Organization
• Cuong Ngoc Huynh, OD

• Physical Therapist in Tamuning, GU
• Providers in Tamuning, GU by specialty
• Physical Therapist in Guam

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.