Provider Demographics
NPI:1861736498
Name:MAGNO, MA. ELAINE JAVIER (PT)
Entity type:Individual
Prefix:MRS
First Name:MA. ELAINE
Middle Name:JAVIER
Last Name:MAGNO
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 1:5814 STARBOARD DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9151
Mailing Address - Country:US
Mailing Address - Phone:224-735-1182
Mailing Address - Fax:
Practice Address - Street 1:5814 STARBOARD DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9151
Practice Address - Country:US
Practice Address - Phone:224-735-1182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP11463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist