MEDICARE: DR. ELEANOR ROSE MAGDALENO DPT

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	225100000X	Physical Therapist	1382751	TX

General Provider Information

NPI Number	:	1346024429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELEANOR ROSE MAGDALENO DPT

Provider Business Mailing Address
First Line	:	3700 S W S YOUNG DR STE 104
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76542-3416
Country	:	US
Telephone Number	:	254-699-3933
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 S W S YOUNG DR STE 104
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76542-3416
Country	:	US
Telephone Number	:	254-699-3933
Fax Number	:

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

Provider Enumeration Date	:	08/21/2023
Last Update Date	:	08/21/2023

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