Provider Demographics
NPI:1417104464
Name:PADRE, ERNESTO T (PT)
Entity Type:Individual
Prefix:MR
First Name:ERNESTO
Middle Name:T
Last Name:PADRE
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 1:4141 W SANDY ST
Mailing Address - Street 2:
Mailing Address - City:BATTLEFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65619-9840
Mailing Address - Country:US
Mailing Address - Phone:417-889-6717
Mailing Address - Fax:
Practice Address - Street 1:509 MEADOWLARK LANE
Practice Address - Street 2:
Practice Address - City:CRANE
Practice Address - State:MO
Practice Address - Zip Code:65633
Practice Address - Country:US
Practice Address - Phone:417-723-5281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000166694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist