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General NPI Number Information
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NPI Number | 1669131173
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Entity Type | Individual
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Provider Name | DAVID SERGIO BAGLIVI PTA
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Gender | Male
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Dates
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Enumeration Date | 12/12/2021
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Last Update Date | 12/12/2021
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Provider Practice Location Address
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Address Line | 2455 N TAMARACK TRL
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City | BLOOMINGTON
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State | IN
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Zip | 47408-1294
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Country | US
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Telephone | 812-336-7060
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Fax |
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Provider Business Mailing Address
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Address Line | 2512 N SKYLINE DR
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City | BLOOMINGTON
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State | IN
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Zip | 47404-1840
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Country | US
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Telephone | 812-369-7118
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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 | 06005827A
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License Number State | IN
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