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General NPI Number Information
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NPI Number | 1447809694
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Entity Type | Individual
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Provider Name | EUGENE PAUL BACOLOD PTA
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Gender | Male
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 15204 W COLONIAL DR
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City | WINTER GARDEN
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State | FL
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Zip | 34787-6042
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Country | US
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Telephone | 407-877-2394
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Fax |
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Provider Business Mailing Address
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Address Line | 646 W SMITH ST UNIT 349
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City | ORLANDO
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State | FL
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Zip | 32804-5381
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Country | US
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Telephone | 832-512-0505
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 29471
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License Number State | FL
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