Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 10179A | AZ |
NPI | 1013318294 |
---|---|
Provider Name | Raul Alberto Pacheco |
First Address | Sun City West, AZ 85375-6021 |
Second Address | Sun City West, AZ 85375-6021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2014 |
Last Update Date | 08/09/2014 |