Provider Demographics
NPI:1568683985
Name:TACARDON, GRACIANO FRANCISCO DOLENDO (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:GRACIANO FRANCISCO
Middle Name:DOLENDO
Last Name:TACARDON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-3001
Mailing Address - Country:US
Mailing Address - Phone:978-683-7379
Mailing Address - Fax:
Practice Address - Street 1:29 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-3001
Practice Address - Country:US
Practice Address - Phone:978-683-7379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPT 10662225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist