Provider Demographics
NPI:1235612664
Name:AGUILAR, LADISLAO (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:LADISLAO
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:LADIS
Other - Middle Name:
Other - Last Name:AGUILAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1717 PRECINCT LINE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3169
Mailing Address - Country:US
Mailing Address - Phone:817-479-7263
Mailing Address - Fax:817-479-3954
Practice Address - Street 1:1717 PRECINCT LINE RD STE 204
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3169
Practice Address - Country:US
Practice Address - Phone:817-479-7263
Practice Address - Fax:817-479-3954
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1310272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist