Provider Demographics
NPI:1629381744
Name:PALAYPAY, AGERICO C JR (PTA)
Entity Type:Individual
Prefix:MR
First Name:AGERICO
Middle Name:C
Last Name:PALAYPAY
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BEALE ST APT 1504
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-4431
Mailing Address - Country:US
Mailing Address - Phone:832-259-8042
Mailing Address - Fax:
Practice Address - Street 1:400 BEALE ST APT 1504
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-4431
Practice Address - Country:US
Practice Address - Phone:832-259-8042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-18
Last Update Date:2010-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 8994225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant