Provider Demographics
NPI:1477647949
Name:CARTAGENA, SERGIO IGNACIO (PT)
Entity Type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:IGNACIO
Last Name:CARTAGENA
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 1:3818 BRANDT STREET
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006
Mailing Address - Country:US
Mailing Address - Phone:713-522-7140
Mailing Address - Fax:713-522-9221
Practice Address - Street 1:3818 BRANDT STREET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006
Practice Address - Country:US
Practice Address - Phone:713-522-7140
Practice Address - Fax:713-522-9221
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1080836225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0004AWOtherBCBS REHAB UNLIMITED, INC
TX81210TOtherBCBS TX
TX456760Medicare ID - Type UnspecifiedTYPE A