Provider Demographics
NPI:1144413469
Name:HIDALGO, JUAN (PT)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:HIDALGO
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 1:4517 BRIDGEPORT DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-4102
Mailing Address - Country:US
Mailing Address - Phone:214-215-0419
Mailing Address - Fax:972-203-1464
Practice Address - Street 1:4517 BRIDGEPORT DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-4102
Practice Address - Country:US
Practice Address - Phone:214-215-0419
Practice Address - Fax:972-203-1464
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1049138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist