Provider Demographics
NPI:1508363227
Name:PANERGO, ELAINE TUCAY (PT)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:TUCAY
Last Name:PANERGO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13774 GAZEBO LN APT 402
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-7558
Mailing Address - Country:US
Mailing Address - Phone:408-449-1482
Mailing Address - Fax:
Practice Address - Street 1:801 ROAD TO SIX FLAGS W
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2616
Practice Address - Country:US
Practice Address - Phone:817-462-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1300781208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation