MEDICARE: BEA KATRINA BAGSIC MERCADO PT, 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	3656	NV

General Provider Information

NPI Number	:	1609539766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEA KATRINA BAGSIC MERCADO PT, DPT

Provider Business Mailing Address
First Line	:	9100 W FLAMINGO RD UNIT 1091
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-6401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2856 E CHEYENNE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-4234
Country	:	US
Telephone Number	:	702-644-1888
Fax Number	:

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

Provider Enumeration Date	:	10/15/2021
Last Update Date	:	10/15/2021

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