Provider Demographics
NPI:1508054636
Name:AGUIRRE, DAGOBERTO JR (PTA)
Entity Type:Individual
Prefix:MR
First Name:DAGOBERTO
Middle Name:
Last Name:AGUIRRE
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 W 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-2569
Mailing Address - Country:US
Mailing Address - Phone:970-380-9206
Mailing Address - Fax:
Practice Address - Street 1:708 22ND ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-7041
Practice Address - Country:US
Practice Address - Phone:970-325-6082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant