Provider Demographics
NPI:1780943688
Name:BACANI, DAVID PAZ (PT, MS)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:PAZ
Last Name:BACANI
Suffix:
Gender:M
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:89 UNIVERSITY ROAD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445
Mailing Address - Country:US
Mailing Address - Phone:857-272-6576
Mailing Address - Fax:
Practice Address - Street 1:2181 WASHINGTON STREET
Practice Address - Street 2:305
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-2082
Practice Address - Country:US
Practice Address - Phone:617-541-0772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist