Provider Demographics
NPI:1619251592
Name:UGALDE, MARIA C (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:C
Last Name:UGALDE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 483
Mailing Address - Street 2:
Mailing Address - City:CUMBY
Mailing Address - State:TX
Mailing Address - Zip Code:75433-0483
Mailing Address - Country:US
Mailing Address - Phone:903-440-2884
Mailing Address - Fax:
Practice Address - Street 1:400 KAUFMAN ST S
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:TX
Practice Address - Zip Code:75457-2834
Practice Address - Country:US
Practice Address - Phone:903-270-6013
Practice Address - Fax:903-270-6031
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2069797225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant