Provider Demographics
NPI:1770677056
Name:MERCADO, DULCE M (MSPT)
Entity Type:Individual
Prefix:
First Name:DULCE
Middle Name:M
Last Name:MERCADO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 HERITAGE TRACE PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76244
Mailing Address - Country:US
Mailing Address - Phone:817-741-7585
Mailing Address - Fax:
Practice Address - Street 1:4120 HERITAGE TRACE PKWY STE 220
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76244
Practice Address - Country:US
Practice Address - Phone:817-741-7585
Practice Address - Fax:817-741-7587
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1170059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist