MEDICARE: DULCE M MERCADO MSPT

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	1170059	TX

General Provider Information

NPI Number	:	1770677056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DULCE M MERCADO MSPT

Provider Business Mailing Address
First Line	:	4120 HERITAGE TRACE PKWY STE 220
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76244
Country	:	US
Telephone Number	:	817-741-7585
Fax Number	:

Provider Business Practice Location Address
First Line	:	4120 HERITAGE TRACE PKWY STE 220
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76244
Country	:	US
Telephone Number	:	817-741-7585
Fax Number	:	817-741-7587

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	12/10/2010

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Directions to “ DULCE M MERCADO MSPT” Practice Location

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