Provider Demographics
NPI:1326635079
Name:BAGBY, GISA (PT)
Entity Type:Individual
Prefix:
First Name:GISA
Middle Name:
Last Name:BAGBY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:GISA
Other - Middle Name:
Other - Last Name:CANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2280 TRAWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3020
Mailing Address - Country:US
Mailing Address - Phone:915-595-3535
Mailing Address - Fax:
Practice Address - Street 1:2280 TRAWOOD DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3020
Practice Address - Country:US
Practice Address - Phone:915-595-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1341081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist