MEDICARE: MYLENE BAGUIO RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	R0891	MO

General Provider Information

NPI Number	:	1306059977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYLENE BAGUIO RPT

Provider Business Mailing Address
First Line	:	1307 HADEN STREET
Second Line	:
City	:	AVA
State	:	MO
Zip	:	65608-5105
Country	:	US
Telephone Number	:	417-683-3380
Fax Number	:	417-683-3386

Provider Business Practice Location Address
First Line	:	1307 HADEN STREET
Second Line	:
City	:	AVA
State	:	MO
Zip	:	65608-5105
Country	:	US
Telephone Number	:	417-683-3380
Fax Number	:	417-683-3386

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	02/04/2022

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Directions to “ MYLENE BAGUIO RPT” Practice Location

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