Ma Farah Diva Libo on Cunanan, PT
Individual provider Active NPI Physical Therapist · Dededo, GU
NPI 1598889982 · NPPES record last updated Aug 8, 2016
Key facts
- NPI
- 1598889982
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT83 (GU)
- Practice address
- 120 North Hasmin Court
Dededo, GU 96929 - Phone
- (671) 858-5758
- NPI assigned
- Mar 19, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT83 | GU | MD | Physical Therapist |
| 027838 | NY | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 027838 | NY | |
| Physical Therapist | 225100000X | PT83 | GU | Yes |
Addresses
Primary practice location
120 North Hasmin Court
Dededo, GU 96929
Mailing address
120 North Hasmin Court
Dededo, GU 96929
Phone (671) 858-5758
Other providers in Dededo, GU
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 8, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.