Provider Demographics
NPI:1497570311
Name:BAGACAY, KHARIZA MAE C (PT,DPT)
Entity type:Individual
Prefix:
First Name:KHARIZA MAE
Middle Name:C
Last Name:BAGACAY
Suffix:
Gender:F
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 1:3615 E JOHN ROWAN BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-3265
Mailing Address - Country:US
Mailing Address - Phone:502-331-4778
Mailing Address - Fax:
Practice Address - Street 1:3615 E JOHN ROWAN BLVD STE 201
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-3265
Practice Address - Country:US
Practice Address - Phone:502-331-4778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist