Provider Demographics
NPI:1205662079
Name:BAGWELL, RANDAL (PT, DPT)
Entity type:Individual
Prefix:
First Name:RANDAL
Middle Name:
Last Name:BAGWELL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 N CARROLL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6613
Mailing Address - Country:US
Mailing Address - Phone:214-887-6580
Mailing Address - Fax:
Practice Address - Street 1:1015 N CARROLL AVE STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6613
Practice Address - Country:US
Practice Address - Phone:214-887-6580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic