Provider Demographics
NPI:1578047981
Name:BADILLO GONZALEZ, INGRID (LMT)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:BADILLO GONZALEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 SNAKE RIVER RD STE D
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-7746
Mailing Address - Country:US
Mailing Address - Phone:346-546-9653
Mailing Address - Fax:832-626-3627
Practice Address - Street 1:1808 SNAKE RIVER RD STE D
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-7746
Practice Address - Country:US
Practice Address - Phone:346-546-9653
Practice Address - Fax:832-626-3627
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
TXMT127296225700000X
TX127296208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty