MEDICARE: PATRICK JOSEPH BAGAN P.T.

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	2251X0800X	Orthopedic Physical Therapist	36243	CA

General Provider Information

NPI Number	:	1144558487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK JOSEPH BAGAN P.T.

Provider Business Mailing Address
First Line	:	3178 HAMNER AVE # 4
Second Line	:
City	:	NORCO
State	:	CA
Zip	:	92860-1936
Country	:	US
Telephone Number	:	951-736-5646
Fax Number	:	951-736-5694

Provider Business Practice Location Address
First Line	:	3178 HAMNER AVE # 4
Second Line	:
City	:	NORCO
State	:	CA
Zip	:	92860-1936
Country	:	US
Telephone Number	:	951-736-5646
Fax Number	:	951-736-5694

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

Provider Enumeration Date	:	11/24/2009
Last Update Date	:	02/11/2021

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