MEDICARE: MR. DIOSDADO A BARAWID JR. PT

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	PT 00003206	TN

General Provider Information

NPI Number	:	1750480042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DIOSDADO A BARAWID JR. PT

Provider Business Mailing Address
First Line	:	PO BOX 171422
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38187-1422
Country	:	US
Telephone Number	:	901-870-4302
Fax Number	:	901-388-4486

Provider Business Practice Location Address
First Line	:	9160 HIGHWAY 64 STE 3
Second Line	:
City	:	LAKELAND
State	:	TN
Zip	:	38002-8094
Country	:	US
Telephone Number	:	901-388-4474
Fax Number	:	901-388-4486

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/08/2007

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