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NPI Code Detail

MEDICARE: DAVE SPENCER MAYUELA TABOADA PHYSICAL THERAPIST

MEDICARE: DAVE SPENCER MAYUELA TABOADA PHYSICAL THERAPIST
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
1225100000XPhysical Therapist05007580AIN

General Provider Information

NPI Number : 1255426144
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVE SPENCER MAYUELA TABOADA PHYSICAL THERAPIST
Provider Business Mailing Address
First Line : 403 N GLENDALE AVE APT 103
Second Line :
City : TOMAH
State : WI
Zip : 54660-1322
Country : US
Telephone Number : 608-372-3971
Fax Number :
Provider Business Practice Location Address
First Line : 403 N GLENDALE AVE APT 103
Second Line :
City : TOMAH
State : WI
Zip : 54660-1322
Country : US
Telephone Number : 608-372-3971
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 07/08/2007

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