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General NPI Number Information
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NPI Number | 1962659086
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Entity Type | Individual
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Provider Name | EDGAR QUINAGORAN BACUD P.T.
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Gender | Male
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Dates
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Enumeration Date | 08/20/2008
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Last Update Date | 11/12/2010
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Provider Practice Location Address
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Address Line | 4206 SOUTH FITZHUGH AVENUE
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City | DALLAS
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State | TX
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Zip | 75210
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Country | US
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Telephone | 214-926-5319
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Fax | 972-412-4603
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Provider Business Mailing Address
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Address Line | 9710 BROADMOOR LANE
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City | ROWLETT
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State | TX
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Zip | 75089
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Country | US
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Telephone | 214-206-6086
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1072247
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License Number State | TX
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