Provider Demographics
NPI:1114348604
Name:MCHARGUE, DOULAS (PT)
Entity Type:Individual
Prefix:
First Name:DOULAS
Middle Name:
Last Name:MCHARGUE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 S HALCYON RD
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3115
Mailing Address - Country:US
Mailing Address - Phone:805-481-5656
Mailing Address - Fax:805-481-5749
Practice Address - Street 1:117 S HALCYON RD
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3115
Practice Address - Country:US
Practice Address - Phone:805-481-5656
Practice Address - Fax:805-481-5749
Is Sole Proprietor?:No
Enumeration Date:2013-12-30
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT009933225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist