Provider Demographics
NPI:1629079496
Name:PACIA, MILAGROS
Entity Type:Individual
Prefix:MRS
First Name:MILAGROS
Middle Name:
Last Name:PACIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E COMMERCE CT
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-3200
Mailing Address - Country:US
Mailing Address - Phone:865-475-3101
Mailing Address - Fax:865-475-9213
Practice Address - Street 1:102 E COMMERCE CT
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-3200
Practice Address - Country:US
Practice Address - Phone:865-475-3101
Practice Address - Fax:865-475-9213
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000002440225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3658803Medicare ID - Type UnspecifiedPHYSICAL THERAPY