Provider Demographics
NPI:1740769215
Name:BAGUES, MARCELA (DPT)
Entity Type:Individual
Prefix:
First Name:MARCELA
Middle Name:
Last Name:BAGUES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 LIVINGSTON LOOP STE B1
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9747
Mailing Address - Country:US
Mailing Address - Phone:575-587-7061
Mailing Address - Fax:915-493-8264
Practice Address - Street 1:103 LIVINGSTON LOOP STE B1
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9747
Practice Address - Country:US
Practice Address - Phone:575-587-7061
Practice Address - Fax:915-493-8264
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty