Provider Demographics
NPI:1013289461
Name:BADIO, FATOUMATA (PTA)
Entity Type:Individual
Prefix:
First Name:FATOUMATA
Middle Name:
Last Name:BADIO
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 1:729 N 77 SUNSHINESTRIP
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8847
Mailing Address - Country:US
Mailing Address - Phone:956-421-4667
Mailing Address - Fax:956-421-2016
Practice Address - Street 1:729 N 77 SUNSHINESTRIP
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8847
Practice Address - Country:US
Practice Address - Phone:956-421-4667
Practice Address - Fax:956-421-2016
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2083243225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX21738201Medicaid
TX21738201Medicaid