Provider Demographics
NPI:1578866968
Name:BACHICHA, ROBERT O (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:O
Last Name:BACHICHA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:O
Other - Last Name:BACHICHA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:4152 SOARING EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-0817
Mailing Address - Country:US
Mailing Address - Phone:505-470-2082
Mailing Address - Fax:505-473-3100
Practice Address - Street 1:4152 SOARING EAGLE LN
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-0817
Practice Address - Country:US
Practice Address - Phone:505-470-2082
Practice Address - Fax:505-473-3100
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2606225100000X
NM2090225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist