Provider Demographics
NPI:1598244501
Name:SAGACE, JOHN D II
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:SAGACE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-5429
Mailing Address - Country:US
Mailing Address - Phone:830-775-2459
Mailing Address - Fax:830-775-4439
Practice Address - Street 1:301 W MARTIN ST
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-5429
Practice Address - Country:US
Practice Address - Phone:830-775-2459
Practice Address - Fax:830-775-4439
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2063387225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant