Provider Demographics
NPI:1003590472
Name:PANCHO, HARRY VERGARA
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:VERGARA
Last Name:PANCHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 STAG DR
Mailing Address - Street 2:
Mailing Address - City:RUCKERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22968-3176
Mailing Address - Country:US
Mailing Address - Phone:434-422-1106
Mailing Address - Fax:
Practice Address - Street 1:117 STAG DR
Practice Address - Street 2:
Practice Address - City:RUCKERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22968-3176
Practice Address - Country:US
Practice Address - Phone:434-422-1106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist