Provider Demographics
NPI:1245518372
Name:MIDDAUGH, DAVID JR (DPT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:MIDDAUGH
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4758 LOMA DEL SUR DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3597
Mailing Address - Country:US
Mailing Address - Phone:915-755-0738
Mailing Address - Fax:915-755-6941
Practice Address - Street 1:4758 LOMA DEL SUR DR
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79934-3597
Practice Address - Country:US
Practice Address - Phone:915-755-0738
Practice Address - Fax:915-755-6941
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX12077092251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB139118Medicare PIN