Provider Demographics
NPI:1780464636
Name:TAGULAO, JOHN LOUIE RAY (PT, DPT)
Entity type:Individual
Prefix:
First Name:JOHN LOUIE RAY
Middle Name:
Last Name:TAGULAO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:TAGULAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:32358 ALPINE CT
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4191
Mailing Address - Country:US
Mailing Address - Phone:951-813-6960
Mailing Address - Fax:
Practice Address - Street 1:38860 SKY CANYON DR BLDG A
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2518
Practice Address - Country:US
Practice Address - Phone:951-304-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT304429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist